Efficacy and Feasibility of Laparoscopic Redo Fundoplication

Abstract

Nearly 15% of patients who undergo anti-reflux surgery report recurrent symptoms on long-term follow-up and may be candidates for redo anti-reflux surgery (redo-ARS). In the last 10years, several studies have evaluated the feasibility and short-term results of redo-ARS. The purpose of the present study was to critically review our experience with 102 redo fundoplications with short- to medium-term follow-up and special emphasis on subjective outcomes for redo-ARS. A retrospective chart analysis was done on consecutive 102 redo fundoplications performed between December 2003 and March 2008. The patients were divided into two groups, the open group (group A) and the laparoscopic (group B). Subjective symptom analysis was performed on an annual basis using a standard questionnaire. There was no significant difference in mean age, body mass index (BMI), or time since first surgery between the two groups. Significant differences were noted between operative time, estimated blood loss, and median hospital stay between the two groups. A total of 16 patients were found to have short esophagus and underwent Collis gastroplasty. Complications included 11 hollow viscus injuries seen in group A and 13 such injuries in group B. There was significant improvement in all symptom scores in the two groups, along with a significant decrease in the use of acid suppression therapy. In the open group 58% of patients rated their satisfaction as excellent compared to 90% in the laparoscopic group. This study clearly establishes the safety and efficacy of redo laparoscopic anti-reflux surgery with excellent outcomes after short- to medium-term follow-up.