Intervențiile chirurgicale repetate în eșecul fundoplicaturii la pacienții cu boala de reflux gastroesofagian

Abstract

Redo surgery in failed fundoplication in patients with gastroesophageal reflux disease. Background. Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of refractory gastroesophageal reflux in surgical clinics, with excellent and good symptomatic results in 90% to 95% of cases. Despite a high rate of success, the failure of laparoscopic fundoplication occurs in 2-17% of cases. When some patients can be treated conservatively, in approximately 3% to 6% cases the revision surgery is required due to recalcitrant and recurrent symptoms or appearance of complications. Methods. From 2011 to 2019, revision surgery was performed on 10 patients (all women) between the ages of 18 and 63 years. Patient demographics, primary and repeat surgery techniques, preoperative symptoms, anatomical pattern of failure, perioperative morbidity, operative complications, conversion rate, length of hospital stay, immediate and distant results were evaluated. Results. The first surgical procedure was laparoscopic Nissen-Rossetti fundoplication in 9 patients and Dor – in 1 patient. The types of fundoplication failure were: transhiatal wrap migration - 6 cases, „slipped” Nissen – 1 and paraesophageal hernia – 3. Eight patients were operated laparoscopically with the conversion rate of 50% (4 cases) – caused by dense adhesions – 3 cases, and perforation of gastric fundus – 1. Nissen fundoplication was redone in 4, converted to Toupet – in 3, newly formed after Dor fundoplication – in 1 and was left in place – in 2 patients. In all cases the repeated cruroplasty was performed, and in 3 cases - reinforcement with Gore-Tex patches. Laparoscopy operating room time was 146±54 minutes (from 95 to 240 minutes). Intraoperative complication occurred in one patient – gastric perforation. Length of hospital stay was 5 days for laparoscopic, 8 days for converted. Follow-up from 4 to 9 years: all patients without reflux symptoms, 1 – mild bloating, 2 – mild dysphagia without hernia and reflux recurrence. Conclusions. The redo surgery it is a more complex intervention, with higher technical requirements than primary one and is associated with a high rate of conversion and intraoperative complications. However, redo surgery can be carried out efficiently and safely by an experienced surgical team in dedicated centers.