Outcome of laparoscopic redo fundoplication

Abstract

We have read with interest the recently published article Outcome of Laparoscopic Redo Fundoplication by Dutta et al. [2]. In this article,the authors review their experience with 28 consecutive patients who underwent laparoscopic revisional fundoplication for primary failed antireflux surgery. On the basis of objective outcome parameters such as results from 24 h of pH monitoring and esophageal manometry,this study shows that laparoscopic refundoplication can be a safe and effective procedure for patients who have failed primary antireflux surgery. A significant decrease in acid reflux and a significant increase in lower esophageal sphincter pressure was achieved for these patients. Additionally,patients showed a significant decrease in gastroesophageal reflux disease symptoms after refundoplication. The field of laparoscopic redo fundoplication is challenging. Therefore,the authors should be congratulated for their excellent results. It has been reported that objective outcome parameters improve after laparoscopic refundoplication [3,4]. However,we believe that long-term evaluation of functional outcome parameters as well as symptomatic outcome and patientrelated factors such as quality of life and patient satisfaction are needed to prove the effectiveness of laparoscopic redo fundoplication. The authors describe a mean follow-up period of 22 months,although they finally evaluated objective criteria 6 months postoperatively. Like other authors [5,6],we totally agree with Dutta et al. [2] that intrathoracic wrap herniation is the most frequent anatomic morphologic complication after laparoscopic fundoplication. Therefore,most authors recommend a sufficient hiatal closure during primary laparoscopic antireflux surgery [1]. In the current study, the authors included four patients whose morphologic cause for reoperation was postoperative wrap herniation. In this group,hiatal hernia,described as the most common cause for reherniation,was not repaired at the initial procedure. It would be interesting to know whether there have been more patients without primary hiatal repair who had no postoperative reherniation of the wrap.