Reoperation for unsatisfactory outcome after laparoscopic antireflux surgery

Abstract

The study includes 12 patients who did not get the symptomatic relief expected (n=10) or developed an acute complication (n-2.) after a laparoscopic antireflux operation. The first reason for failure was initial misdiagnosis of the underlying foregut disease, i.e. excessive duodenogastric reflux (n = 2), and antral gastrin cell hyperplasia (n = 1). The second reason was inappropriate surgical technique (= 11), i.e. no approximation of the crura (n = 8), no division of the short gastric vessels (n = 6), placement of the wrap around the stomach (n = 4), disruption of the antireflux repair ( = 2), herniation of the wrap into the chest (n = 5), necrotic perforation of the gastric wall (n-2), volvulus of the stomach (n = 3), and/or inadvertent truncal vagotomy (n-2). Hard intra-abdominal adhesions were found in six patients. In conclusion, laparoscopic antireflux surgery requires accurate diagnosis of the underlying foregut disorder and adherence to well-proven technical principles of antireflux surgery to succeed. It fails to prevent development of hard adhesions in the dissected areas. Within a short period of time, laparoscopy has been proved to be an elegant and reliable surgical approach to gastroesophageal junction, and short-term results of laparoscopic antireflux operations 1 ^3 in terms of postoperative complication, symptomatic relief, and restoration of an effective lower esophageal sphincter are quite comparable to those obtained with conventional surgery. However, little 4 has been published yet on patients who require remedial surgery because they don't get the symptomatic relief expected after laparoscopic antireflux operation. The present study reports the experience of the Louvain Medical School Hospital with such patients.