LONG-TERM RESULTS AFTER REOPERATION FOR FAILED ANTIREFLUX PROCEDURES

From January 1960 to June 1995, 185 patients underwent reoperation wit hout esophageal resection for symptoms of recurrent gastroesophageal r eflux disease, There were 102 men and 83 women. Median age was 58 year s (range 20 to 84 years), A single previous antireflux operation had b een performed in 147 patients, two in 33, and three in 5, The median i nterval between the reoperation and the previous operation was 36 mont hs (range 1 to 291 months), Indications for reoperation were symptoms in 184 patients and a large paraesophageal hernia in one patient, The surgical approach was by means of a thoracotomy in 133 patients (71.9% ), laparotomy in 27 (14.6%), and a thoracoabdominal incision in 25 (13 .5%), A Nissen fundoplication was performed in 107 patients (57.8%), B elsey fundoplication in 47 (25.4%), truncal vagotomy and antrectomy wi th Roux-en-Y reconstruction in 17 (9.2%), anatomic hernia repair in 12 (6.5%), and Hill gastropexy in 2 (1.1%), A Collis gastroplasty was ad ded to the fundoplication in 116 patients (62.7%), and a pyloroplasty was performed in 17 (9.2%), There was one operative death (0.5%), Comp lications occurred in 47 patients (25.4%), Median postoperative hospit alization was 9 days (range 5 to 58 days), Follow-up was complete in 1 56 patients (84.3%) and ranged from 3 to 283 months (median 44 months) , Improvement occurred in 137 patients (87.8%), Functional results wer e classified as excellent in 65 patients (41.6%), good in 29 (18.6%), fair in 43 (27.6%), and poor in 19 (12.2%), No single operative approa ch or procedure proved to be functionally superior, We conclude that r eoperation with esophageal preservation after a failed antireflux proc edure will result in significant functional benefit and can be perform ed with low mortality and acceptable morbidity, The type of repair sho uld be tailored to the individual patient.