medigraphic.com

2016, Number 3

Rev Mex Cir Endoscop 2016; 17 (3)

Experience in laparoscopic re-operation of anti-reflux surgery: Description of technique and long-term results

Decanini TC, Estrada GRA, Vega JM, Obregón MJG

Language: Spanish
References: 23
Page: 139-145
PDF size: 476.66 Kb.


ABSTRACT

Introduction: Anti-reflux-surgery failure is manifested mainly by dysphagia and Gastro-esophageal reflux symptoms. This clinical presentation frequently drives the physician to request complementary studies. Discussion: The laparoscopic re-operation of the esophageal hiatus is a great surgical challenge. It also carries a high morbidity, high conversion possibilities and less success rate to improve symptoms than primary intervention. Material and method: This is a retrospectives study. Clinical files were reviewed of all patients that went through a surgical re intervention after a laparoscopic anti-reflux surgery during the period from August 1st 1999 to August 31st 2013 at Centro Medico ABC. Multivariate analysis of clinical evolution, Symptoms, cause or mechanism of failure, operative time also trans and postoperative complications. Results: 135 esophageal hiatus re-operations were performed in a period of 14 years. Dysphagia was the main complaint 50% and GERD in 46%. The average interval between the primary anti-reflux surgery and re operation was 26.8 months. The most common complication was left pneumothorax with an index of conversion of 4.4%. The most frequent mechanism of failure was a proximal migrating fundoplication in 41.5%. The average operative time was 129 min. a new Nissen procedure was performed in 77% of the patients and the average hospital stay was 2.9 days. Conclusion: According to available international data esophageal hiatus re-operation is feasible, safe and effective. This is the most extensive study in Latin America and the second worldwide.


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