Laparoscopic revision surgery for gastroesophageal reflux disease.

Abstract

Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases.From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated.The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers.