Complications and Pitfalls of Open and Laparoscopic Antireflux Surgery

Abstract

Background: With the introduction of the laparoscopic approach, antireflux surgery has recently experienced a renaissance as an effective and minimally invasive alternative to life long medical treatment in patients with gastroesophageal reflux disease. Antireflux surgery, whether performed via the traditional open or new laparoscopic approach, is, however, not devoid of complications and failures. Methods: The current literature on open and laparoscopic antireflux surgery was reviewed with focus on complications, side effects and failures. Results: Independent of the surgical approach, complications occur in up to 12 % of patients. Up to 15 % of patients who had an antireflux operation will experience some form of recurrent, persistent or new symptoms. An analysis of failed antireflux procedures shows that technical errors during the initial procedure and wrong patient selection account for the vast majority of the failures. The management of patients with a failed antireflux procedure requires an individual therapeutic approach based on the presenting symptoms, the results of function tests, and the intraoperative findings. The surgeon caring for patients with failed antireflux procedures should be intimately acquainted with the whole spectrum of revisional, resective, and reconstructive procedures of the stomach, cardia, and esophagus. Conclusions: A profound understanding of the pathophysiology of gastroesophageal reflux disease, a careful selection of patients, a meticulous attention to the technical details of the procedure and an appreciation of the potential sources of failure are therefore the key to successful antireflux surgery. In this respect the selection of the surgical access, i.e. laparoscopic or via laparotomy, appears of minor importance.