Pérez PY, Farah OSI, Lara GVR, Martínez CT, Andrade BA

Language: Spanish
References: 25
Page: 112-118
PDF size: 229.52 Kb.

ABSTRACT

Introduction: Anti-reflux laparoscopic surgery has been performed much more frequently since its introduction in 1991, with a success rate between 85-95%. In the unsuccessful cases, symptoms remain, recur or complications appear. Therefore, the need of a checkup surgical procedure for a fundoplication, is directly proportional to the increase of primary surgical procedures, specially in those cases with incomplete pre-op assessment, deficient surgical technique and patient with a high BMI. We report our cases after a 12 year experience in laparoscopic re-operations of GERD recurrence. Material and methods: Patients re-operated for GERD between 2005 and 2017 were selected. Those patients included had persistence, recurrence of GERD symptoms and/or the presence of dysphagia. The variables analyzed were demographics, background, symptoms and also the description and type of primary surgical procedure. The intra-op variables included the mechanism of failure, surgical time, bleeding and the trans-op and post-op complications. Results: A total of 47 patients were collected; 43 patients had only one anti-reflux operation and 4 patients had two or more procedures. The average time between the primary anti-reflux surgery and the re-operation was 5.9 years. The most common symptoms were heartburn (65%), reflux (68%), dysphagia (42%), epigastric pain (14%) and respiratory symptoms (12%). The probable causes of the failure from the previous surgeries found during trans-op were; migration of the fundoplication (45.6%), laxitud of the fundoplication (17.3%), para-esophageal hernia (15%), fundoplication on the body of the stomach (8.6%), disruption of the fundoplication (4%). In 84% of these cases a new Nissen fundoplication was performed. The trans-op morbidity was 18% with no mortalities in our series. Conclusions: The laparoscopic approach in hiatal re-operation for GERD is feasible with an acceptable morbidity however, it’s important to have the proper equipment and additional devices for the management of the trans-op incidents. The systematization on the pre-op assessment should include functional testing for an adequate selection of treatment.

REFERENCES

1. Ortiz I, Targarona E, Pallares L, Marinello F, Balague C, Trias M. Calidad de vida y resultados a largo plazo de las reintervenciones efectuadas por laparoscopía tras cirugía del hiato esofágico. Cir Esp. 2009; 86: 72-78.

2. Lamb PJ, Myers JC, Jamieson GG, Thompson SK, Devitt PG, Watson DI. Long-term outcomes of revisional surgery following laparoscopic fundoplication. Br J Surg. 2009; 96: 391-397.

3. Smith CD, McClusky DA, Rajad MA, Lederman AB, Hunter JG. When fundoplication fails: redo? Ann Surg. 2005; 241: 861-869.

4. Van Beek DB, Auyang ED, Soper NJ. A comprehensive review of laparoscopic redo fundoplication. Surg Endosc. 2010; 07: 706-712.

5. Dallemagne B, Arenas SM, Francart D, Perretta S, Weerts J, Markiewicz S et al. Long-term results after laparoscopic reoperation for failed antireflux procedures. Br J Surg. 2011; 98: 1581-1587.

6. Hatch KF, Daily MF, Christensen BJ, Glasgow RE. Failed fundoplications. Am J Surg. 2004; 188: 786-791.

7. Stein HJ, Feussner H, Siewert JR. Failure of antireflux surgery: causes and management strategies. Am J Surg. 1996; 171: 36-39.

8. Richter JE. Gastroesophageal reflux disease treatment: side effects and complications of fundoplication. Clin Gastrenterol Hepatol. 2013; 11: 465-471.

9. Andrade-Bucio JA, Pérez-Ponce Y, Lozano CR, Andrade-Bucio AF, Berrones SG, Jaramillo-Martínez C, Muñoz IJ, Rodríguez OF. Tres factores de posible implicación a la falla de funduplicatura identificados en la reoperación laparoscópica en el Centro Médico ISSEMyM. Rev Mex Cir Endoscop. 2013; 14: 10-17.

10. Pointer R, Bammer T, Then P, Kamolz T. Laparoscopic refundoplications after failed antireflux surgery. Am J Surg. 1999; 178: 541-543.

11. Symons N, Purkayastha S, Dillemans B, Athanasiou T, Hanna G, Darzi A et al. Laparoscopic revision of failed antireflux surgery: a systematic review. Am J Surg. 2011; 202: 336-343.

12. Frantzides C, Madan A, Carlson MA, Zeni TM, Zografakis JG, Moore RM et al. Laparoscopic revision of failed fundoplication and hiatal herniorraphy. J Laparoendosc Adv Surg Tech A. 2009; 19: 135-139.

13. Markar SR, Karthikesalingam AP, Wagner OJ, Jackson D, Hewes JC, Vyas S et al. Systematic review and meta-analysis of laparoscopic Nissen fundoplication with or without division of the short gastric vessels. Br J Surg. 2011; 98: 1056-1062.

14. Furnée EJ, Draaisma WA, Broeders IA, Smout AJ, Vlek AL, Gooszen HG. Predictors of symptomatic and objective outcomes after surgical reintervention for failed antireflux surgery. Br J Sur. 2008; 95: 1369-1374.

15. Hunter JG, Smith CD, Branum GD, Waring JP, Trus TL, Cornwell M et al. Laparoscopic fundoplication failures: patterns of failure and response to fundoplication revision. Ann Surg. 1999; 230: 595-604.

16. Carlson MA, Frantzides CT. Complications and results of primary minimally invasive antireflux procedures: a review of 10,735 reported cases. J Am Coll Surg. 2001; 193: 428-439.

17. Fischer A, Thomusch O, Benz S, Von Dobschuetz E, Baier P, Hopt UT. Nonoperative treatment of 15 benign esophageal perforations with self-expandable covered metal stents. Ann Thorac Surg. 2006; 81: 467-472.

18. Awais O, Luketich JD, Schuchert MJ, Morse CR, Wilson J et al. Reoperative antireflux surgery for failed fundoplication: an analysis of outcomes in 275 patients. Ann Thorac Surg. 2011; 92: 1083-1090.

19. Frantzides CT, Madan AK, Carlson MA, Stavropoulos GP. Prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg. 2002; 137: 649-652.

20. Targarona EM, Bendahan G, Balague C, Garriga J, Trias M. Mesh in the hiatus: a controversial issue. Arch Surg. 2004; 139: 1286-1296.

21. Tam V, Winger DG, Nason KS. A systematic review and meta-analysis of mesh versus suture cruroplasty in laparoscopic large hiatal hernia repair. Am J Surg. 2016; 211: 226-238.

22. Müller-Stich BP, Kenngott HG, Gondan M, Stock C, Linke GR, Fritz F et al. Use of mesh in laparoscopic paraesophageal hernia repair: a meta-analysis and risk-benefit analysis. PLoS One. 2015; 10: e0139547. doi: 10.1371/journal.pone.013954

23. Granderath FA, Granderath UM, Pointner R. Laparoscopic revisional fundoplication with circular hiatal mesh prosthesis: the long-term results. World J Surg. 2008; 32: 999-1007.

24. Zhang C, Lui D, Li F, Watson DI, Gao X, Koetje JH et al. Systematic review and metanalysis of laparoscopic mesh versus suture reparir of hiatus hernia: Objective and subjective outcomes. Surg Endosc. 2017; doi.org/10.1007/s00464-017-5586-x.

25. Banki, F, Kaushik C, Roife D, Chawla M, Casimir R, Miller CC 3rd. Laparoscopic reoperative antireflux surgery: a safe procedure with high patient satisfaction and low morbidity. Am J Surg. 2016; 212: 1115-1120.