2006, Number 2
Cir Cir 2006; 74 (2)
Spaventa-Ibarrola AG, Decanini-Terán C, Becerril-Martínez G, González-Lazzeri S
PDF size: 66.04 Kb.
ABSTRACTBackground: We undertook this study to identify the main causes leading to a failed funduplication and to determine the feasibility and effectiveness of reoperation by laparoscopic approach.
Methods: A retrospective and descriptive study was carried out with a review of patient charts. Patients were reoperated for failed antireflux surgery between January 1999 and September 2004.
Results: Sixteen patient charts were reviewed, 10 men (62.5 %) and 6 women (37.5 %), average age 42.1 ± 15.4 years (21 to 72 years). Main preoperative symptoms were severe reflux in seven patients (43.7 %), severe dysphagia in five (31.3 %), and dysphagia and pain in four (25 %). Thirteen patients (81 %) had previous Nissen laparoscopic funduplication (NL), one (6 %) open Nissen (ON) and two (13 %) open Toupet (OT). Four patients were reoperated with open surgery (two Nissen and two Toupet), and 12 laparoscopically (11 Nissen and 1 Toupet). The main causes of dysfunction were a) in LN: sliding of the funduplication in five patients (38 %), angulation of the funduplication in three (23 %) and others; b) in ON: sliding of the funduplication in one patient; and c) in OT: posterior sliding of the funduplication in two cases. The hospital stay for the laparoscopic group was 3.5 ± 1 days (2 to 5 days) and for the open group, 5.2 ± 1.3 days (4 to 7 days, p ‹ 0.013, Student t-test). Morbidity 1 month postoperatively was 37.5 %. Also reported were abdominal distention (19 %), occasional distention with dysphagia (12 %), reflux (6.5 %), with 0 % mortality.
Conclusions: Laparoscopic reoperation for failed antireflux surgery is feasible with an acceptable morbidity and good results.