RT Journal
A1 Curet MJ, Josloff RK, Schoeb O, Zucker KA
T1 LAparoscopic reoperation for failed antireflux procedures
JF Archives of Surgery
JO Archives of Surgery
YR 1999
FD May 1
VO 134
IS 5
SP 559
OP 563
DO 10.1001/archsurg.134.5.559
UL http://dx.doi.org/10.1001/archsurg.134.5.559
AB Background 
    Laparoscopic fundoplication has become the criterion standard for the surgical treatment of gastroesophageal reflux disease. Recently, several patients were referred with recurrent symptoms of gastroesophageal reflux disease or severe dysphagia following previous antireflux surgery for possible laparoscopic reoperation.Hypothesis 
    To determine the safety and efficacy of this procedure.Design 
    Case series, consecutive sample.Setting 
    University-affiliated and community tertiary care hospitals.Patients 
    Prospective study of 27 consecutive patients undergoing attempted laparoscopic reoperation for symptoms of recurrent gastroesophageal reflux disease or intractable dysphagia following antireflux surgery. Patients were available for follow-up for 1 to 60 months postoperatively.Interventions 
    All patients underwent preoperative workup and attempted laparoscopic reoperation for treatment of symptoms.Main Outcome Measures 
    Data were collected on preoperative symptoms and evaluation, operative time, blood loss, time to regular diet, length of hospitalization, morbidity, mortality, and long-term results.Results 
    Twenty-six patients underwent successful laparoscopic operations, with no mortality and minimal morbidity. One patient underwent conversion to open laparotomy and then developed a proximal gastric leak, which was treated conservatively. Twenty-four patients began a liquid diet by postoperative day 1, and most were discharged from the hospital by postoperative day 3. One patient required dilation for postoperative dysphagia. The remaining patients are doing well and none have required treatment with acid-reducing medication.Conclusions 
    Although technically challenging, laparoscopic reoperation for recurrent gastroesophageal reflux disease can be performed safely and with excellent results. In the hands of experienced endoscopic surgeons, patients who have undergone unsuccessful antireflux surgery should be offered laparoscopic reoperation.