SECONDARY ANTIREFLUX SURGERY | ||
| The Egyptian Journal of Surgery | ||
| Volume 26, Issue 1, January 2007, Pages 24-32 PDF (218.51 K) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2007.372329 | ||
| Author | ||
| Ahmed Abdel-Raouf* | ||
| Gastroenterology Surgical Center, Mansoura University, Egypt | ||
| Abstract | ||
| Aim: With the introduction of laparoscopy, the number of antireflux surgeries (ARS), and consequently failed fundoplications, had increased many folds. We report the mechanisms of fundoplication failure in patients having ARS, and present our experience in surgical correction of such failure. Methods: Twenty three patients who had failed fundoplication were reoperated. Pre- and postoperative evaluation of patients included symptom severity, endoscopy, barium study, esophageal motility and 24-hour pH metry. Results: The initial procedures were Nissen in 13, Toupet in 8, and Nissen-Rossetti in 2 patients. The causes of failure were transdiaphragmatic migration of fundoplication (n=6), disrupted fundoplication (n=5), tight fundoplication (n=4), slipped/misplaced fundoplication (n=3), paraesophageal herniation (n=3), and tight crural repair (n=2). The secondary ARS performed were Nissen (n=12), Toupet (n=7), paraesophageal hernia repair with crural repair (n=2), widening of a tight crural repair (n=1), and taking down fundoplication (n=1). Per- (n=4) and postoperative (n=5) complications were minor with no mortality. At Follow-up, symptoms were significantly improved. Conclusion: Reoperations for failed ARS may be performed safely with excellent results. Proper patient selection and paying attention to some technical details at initial ARS could safe the patient another surgery. | ||
| Keywords | ||
| Antireflux surgery; reoperation; fundoplication | ||
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