Laparoscopic redo anti-reflux surgery: Case-series of different presentations, varied management and their outcomes

Abstract

Background: A minority of patients undergoing surgery for refractory gastroesophageal reflux disease (GORD) will require revision antireflux surgery ("redo-ARS") for persistent symptoms or complications. Although a repeat minimally invasive procedure for revision may be technically challenging due to post-operative changes, studies are beginning to show favourable data for the laparoscopic approach.

Method: From a single institution 41 consecutive cases of laparoscopic redo-ARS performed by the same surgeon were classified by mode of presentation to analyse their intra-operative findings, management and post-operative outcomes. Cases were classified as either early, emergency or late.

Results: There were 12 early, 4 emergency and 25 late redo-ARS cases. Complete resolution of symptoms, using the criteria of less than weekly symptoms and off all anti-reflux medications, were acquired in 6 (50%), 2 (50%) and 16 (64%) patients within the early, emergency and late groups respectively. Overall morbidity following revision was 7.3% with no mortality. There were no open conversions.

Conclusion: Although fewer patients will achieve complete resolution of symptoms as compared with outcomes following primary ARS, laparoscopic revision of ARS is a safe and effective approach for the revision of anti-reflux surgery in the early, emergency and elective settings.

Keywords: Anti-reflux surgery; Hiatus hernia; Laparoscopic anti-reflux surgery; Nissen's fundoplication; Redo surgery.