Abstract
Redo antireflux surgery is an advanced surgical procedure which encompasses the following usual steps: takedown of the previous fundoplication, repair of the hiatal defect followed by the actual antireflux procedure. The aim of our extensive review of current relevant literature is to discuss the indications, techniques, complications and limitations of this surgery. In reoperations, a great percentage of surgeons favor the short floppy Nissen, although partial plications or gastrojejunostomies are also practiced. A shortened esophagus is usually one of several causes for reflux reoccurrence, and requires either an extended periesophageal dissection or a Collis gastroplasty. The surface of the hiatal defect, rather than its diameter, is the most important indication for repair. Many repair variants have been introduced and tested, showing that antireflux surgery is still awaiting ideal prosthetic material, whereas details regarding tailoring, placement and suturing of current meshes are subjects of debate. The most frequent complication is gastric perforation; others include pulmonary or cardiac failure, infections, and acute pancreatitis. Mortality approaches 1% with a procedure success rate of 80%. Thus, due to its complexity and challenges, redo antireflux surgery should be performed by an experienced team in a tertiary center to increase its success rate.
Highlights
The antireflux surgery for medical treatment of refractory gastroesophageal reflux disease (GERD) has a satisfactory outcome in up to 90% of patients
When medical treatment fails to relieve these symptoms, reoperation is recommended with reported rates varying between 6.9-15% (Zhou et al, 2015; Richter, 2013)
A redo-fundoplication (RF) on the proximal gastric stump may be performed; this is not necessary since the Roux-en-Y loop (RNY) is sufficient as an antireflux procedure
Summary
The antireflux surgery for medical treatment of refractory gastroesophageal reflux disease (GERD) has a satisfactory outcome in up to 90% of patients. The essential steps of redo antireflux surgery are: (1) removal of the previous fundoplication, (2) repair of the hiatal defect as needed, and (3) antireflux procedure (Mittal et al, 2013). In the case of delayed gastric emptying, a history of gagging or retching, a short esophagus especially with decreased motility, morbid obesity, a failed Collis gastroplasty, or a history of three or more failed previous antireflux surgeries, a Roux-en-Y loop (RNY) is indicated instead of fundoplication (Mittal et al, 2013).
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