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ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2007, Number 3

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Cir Gen 2007; 29 (3)

Reoperation for failed antireflux surgery

Velázquez GJA, Bevia PF, Delgadillo TG, Servín TE, Serrano GI, Marmolejo EJ, Ortiz De La PSIlD, Sánchez GFJ

Language: Spanish
References: 19
Page: 181-187
PDF size: 128.54 Kb.


ABSTRACT

Objective: To determine the causes that lead to failed fundoplication, as well as to assess the efficacy of open revisional surgery and repair of the fundoplication.
Setting: Specialty Hospital of the National Medical Center “La Raza” (IMSS, Mexican Institute of Social Security).
Design: Descriptive, transversal study.
Statistical analysis: Descriptive statistics and univariate analysis.
Patients and methods: We included all patients subjected to fundoplication with persistent or recurrent symptomatology, which required open revisional surgery, identifying the alterations encountered during surgery and the repair made, during the period from January 1, 1992 to December 31, 2006.
Results: From the 1,142 patients subjected to fundoplication, 47 (4.11%) needed revisional surgery. The original surgery corresponded to open Nissen technique in 32 patients (68%). The most frequent symptomatology was recurrent reflux in 19 patients (40%), followed by dysphagia in 17 (36%). The surgical finding that explained most of the failed fundoplications was disruption in the approximation of esophageal hiatus´s crura in eight (27%), stenosis and disruption of the fundoplication with seven (23%), each. The surgery most frequently performed during re-operation was the Guarner-type fundoplication in 10 (21%) cases, and repair of the esophageal hiatus´s crura in 9 (19%). Other procedures were that of Nissen with closure of pillars in seven (15%) and that of Belsey-Mark IV with four (9%) cases. The 3-month follow-up revealed no recurrences of symptoms in 91% of the cases.
Conclusions: Esophageal hiatus´s crura Disruption is the most frequent cause of failed fundoplication in our milieu. A successful re-operation depends on an adequate pre-operative protocol and on the expertise of the surgeon.


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