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ISSN 1665-2576 (Print)

2013, Number 1

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Rev Mex Cir Endoscop 2013; 14 (1)

Three possible factors involved in the failure of fundoplication identified in laparoscopic reoperation at the Centro Médico ISSEMYM

Andrade-Bucio JA, Pérez-Ponce Y, Lozano CR, Andrade-Bucio AF, Guillermo Berrones SG, Jaramillo-Martínez C, Muñoz IJ, Rodríguez OF

Language: Spanish
References: 31
Page: 10-17
PDF size: 349.15 Kb.


ABSTRACT

Background: Failure rates for laparoscopic Nissen fundoplication are 2% to 17% usually associated to crural closure or transdiafragmatic migration. Patient and methods: Authors reviewed medical record from February 2003 to February 2012 of patients who had a previous fundoplication for gastro-esophageal reflux disease that underwent reoperative surgery. We considered aspects that may influence for results such as: gender, body mass index, transoperative findings, prosthetic material used at redo procedure, surgical complications and postoperative symptoms among others. Postoperative results were assessed with upper gastrointestinal series. Results: Twenty three patients had laparoscopic redo, 64% were female, 78% of cases had a body mass index › 24.9 Kg/m2. Intra-thoracic migration of fundoplication (74%) along with opened crura (26%) and failure of fixing the wrap (44%) were the most common findings at reoperation. In 26% of cases had prosthetic mesh for crural reinforce. Most frequent complications were gastric perforation (17%) followed by pneumothorax (13%). Post operative disphagia was reduced 56.5%, heartburn 66% and regurgitation 56%. Classic Nissen was the surgical technique most employed (65%) Conclusions: Redo surgery at laparoscopic approach is an effective and safe method. Associated factors for recurrence at primary anti-reflux surgery are: a high body mass index, failure to close diaphragmatic crura and failure to fix wrap.


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