Laparoscopic Revisional Antireflux and Hiatal Hernia Surgery Results in a Higher Rate of Complications and Severity at 90-days Than Primary Surgery

Abstract

ObjectiveData on graded complications and their frequency after laparoscopic revisional antireflux and hiatal hernia surgery compared to primary surgery are lacking. We describe 30- and 90-day morbidity using the Clavien-Dindo (CD) classification. Methods298 patients underwent revision surgery between 2003-2020 and were propensity matched to primary surgeries [1:2 ratio] based on age, sex, BMI, ASA classification, LA grade esophagitis, presence of Barrett's, and indication for surgery. Complications were graded using the CD classification, with the highest grade of complication reported per patient. ResultsAfter matching, both groups were majority females, with a median age of 60 and a median BMI of 29.5. Most were healthy, with non-erosive esophagitis and modest levels of Barrett's esophagus. A laparoscopic Nissen fundoplication was most common; however, a partial fundoplication was more common in revisions. Mesh, relaxing incisions and Collis were more common in revisional surgery.At 30-days, total complications were similar [23.5%, (70/298) versus 20.6% (123/596), p=0.373] with 1 death in each group. Minor complications (<CD3A) were comparable. Revision patients experienced CD3B complications (4.7% vs 5 0.8%, p>0.001) more frequently, with esophageal obstruction requiring revision and esophageal/gastric leak being most common. Grade CD4A/B complications were comparable in both groups. At 90-days, revision patients experienced overall complications [7.1% (21) vs 2.0% (12), p=0.003], and CD3B complications [1.0% (3) vs 0 , p=0.037] more frequently, with intra-abdominal abscess washout being the most common CD3B complication. ConclusionRevisional surgery results in similar total complications at 30 days but additional complications can occur out to 90 days.