Dallemagne B, Weerts J, Jehaes C

Language: Spanish
References: 17
Page: 19-24
PDF size: 174.83 Kb.

ABSTRACT

Objective: Anatomic fundoplication failure may occur after laparoscopic antireflux surgery (LARS). When untoward symptoms occur after surgery, it is appropriate to assess the cause of the symptoms, which may result from physiologic problems (e.g., foregut motility disturbances, non-GERD disease processes, recurrent GERD with an intact fundoplication) or secondary to anatomic failure of the fundoplication (e.g., intrathoracic migration, slippage down onto the stomach, disruption of the fundoplication). The authors’ aims were to assess the incidence, presentation, precipitating factors, and management of anatomic fundoplication failures after LARS. Methods: The patient population consisted of 37 consecutive patients undergoing redo surgery for failed LARS between 1992 and 2001. The presenting symptom for investigation was new onset dysphagia in 11 patients, associated with recurrent heartburn in 4 patients, thoracic pain in 3 patients, bloating in 1 patient, recurrent GERD symptoms in 18 patients. Four patients had no symptoms. Results: Anatomic failure of the antireflux mechanism was demonstrated in 34/37 patients: intrathoracic migration of the fundoplication in 16 patients, slipped or misplaced fundoplication in 15 patients, tightened crural repair in 3 patients. A normal fundoplication was demonstrated in 3 patients. All but one patient underwent reoperation under laparoscopic guidance. Conclusions: Contributing factors of anatomic failure after LARS may include inadequate closure of the diaphragmatic crura, a short esophagus and/or inadequate mobilization of the esophagus, inadequate anchoring of the valve to the esophageal wall, and physiologic factor that would tend to increase the pressure or tension at the esophageal hiatus. Full esophageal mobilization, a loose wrap, and meticulous closure of the diaphragmatic crura posterior to the esophagus should minimize anatomic and functional failure after LARS.

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