FAILURE OF ANTIREFLUX SURGERY - CAUSES AND MANAGEMENT STRATEGIES

BACKGROUND: With wider use of laparoscopic antireflux surgery, failed antireflux procedures are likely to become more common. METHODS: The c auses of failure, management strategies, and outcome were analyzed in a consecutive series of 105 patients with failed antireflux procedures . RESULTS: Recurrent reflux was the most common primary symptom for re ferral (44.7%), followed by dysphagia (32.3%), and a combination of dy sphagia and reflux (15.2%), The reasons for failure were disruption of the initial antireflux procedure (46%), a displaced repair (23%), a t oo-tight or too-long fundoplication (10%), an unrecognized motor disor der (9%), a paraesophageal or axial herniation (6%), or gastric denerv ation (6%). Revisional surgery was required in 71 patients, and 34 pat ients were managed conservatively. Intraoperative assessment during re operation showed that technical errors during the initial procedure we re responsible for failure in 40 of 71 patients. With an individual th erapeutic approach, good results were achieved in 86% of patients unde rgoing revisional surgery. CONCLUSIONS: Technical factors and inapprop riate patient selection are the most common reasons for failure of ant ireflux surgery. An individual therapeutic approach based on an exact analysis of the reasons for failure of the initial procedure is essent ial for the successful management of these patients.