Reoperative laparoscopic fundoplication for the treatment of failed fundoplication

Pavlos K. Papasavas, Woodrow W. Yeaney, Rodney J. Landreneau, Fernando D. Hayetian, Daniel J. Gagné, Philip F. Caushaj, Robin Macherey, Susan Bartley, Richard H. Maley, Robert J. Keenan

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

Objective This study was undertaken to determine the safety and efficacy of reoperative laparoscopic fundoplication for patients with failed fundoplication. Methods Thirty-nine of 612 consecutive patients who had undergone fundoplication underwent laparoscopic reoperative fundoplication for recurrent symptoms, persistent dysphagia, or gas bloat. An additional 15 patients were referred from outside facilities for reoperation. Preoperative evaluation included barium swallow (n = 54), esophagogastroduodenoscopy (n = 54), esophageal manometry (n = 34), and 24-hour ambulatory pH measurement (n = 32). Symptom severity before and after surgery was evaluated with a visual analog scoring scale. The mean follow-up was 22.5 months. Results The primary symptoms that led to reoperation in the 54 patients were heartburn (n = 26), dysphagia (n = 23), and gas bloat (n = 5). Average time from initial operation to reoperation was 22.7 months. There were 3 conversions to open technique. An anatomic reason for the failure of the initial fundoplication was found in 69% of cases: slipped or misplaced fundoplication (n = 14), disrupted fundoplication (n = 8), transdiaphragmatic herniation (n = 7), achalasia (n = 1), and tight fundoplication (n = 7). Fourteen patients had 15 perioperative complications. Mean hospital stay was 2.3 days. Symptoms such as heartburn, dysphagia, and gas bloat improved significantly after reoperation; 40% to 50% of patients had scores 0 to 2, 21% to 45% had scores 3 to 7, and 9% to 29% had scores 8 to 10. Proton-pump inhibitor use after operation decreased from 88% to 36%. Fifty-two percent of patients completely discontinued any antireflux medications. Three patients had failure of the reoperation and required additional procedures. Conclusion Laparoscopic reoperation for failed fundoplication is feasible and can achieve resolution of symptoms for a significant percentage of patients.

Original languageEnglish (US)
Pages (from-to)509-516
Number of pages8
JournalJournal of Thoracic and Cardiovascular Surgery
Volume128
Issue number4
DOIs
StatePublished - Oct 1 2004
Externally publishedYes

Keywords

  • 28
  • 8

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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    Papasavas, P. K., Yeaney, W. W., Landreneau, R. J., Hayetian, F. D., Gagné, D. J., Caushaj, P. F., Macherey, R., Bartley, S., Maley, R. H., & Keenan, R. J. (2004). Reoperative laparoscopic fundoplication for the treatment of failed fundoplication. Journal of Thoracic and Cardiovascular Surgery, 128(4), 509-516. https://doi.org/10.1016/j.jtcvs.2004.04.037