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Laparoscopic revision for failed anti-reflux surgery. Preliminary results.

BACKGROUND/AIMS
Surgical treatment of gastroesophageal reflux disease has become common practice. These operations are known to fail in about 10%, the need for re-intervention approximates 5%. Re-fundoplications are feasible laparoscopically but are technically demanding.


METHODOLOGY
For the present paper, we reviewed retrospectively the 10 patients that, in our practice, needed a re-intervention for failure of a prior fundoplication. The causes were: narrowed passage at wrap level (n=4), intra-thoracic wrap migration (n=3), wrap disruption (n=2) and gastric volvulus (n=1).


RESULTS
All 10 patients underwent a re-operation consisting of a confection of a new 360 degrees wrap. All interventions were completed laparoscopically and no major complication occurred. The results of these revised fundoplications were satisfying with complete resolution of reflux and/or dysphagia in all patients but one. This latter patient still needed anti-acid medication for an unexplained persistent reflux.


CONCLUSIONS
In our experience, laparoscopic correction of failed fundoplications is technically feasible and associated with low rate of complications and high success rate.