LAPAROSCOPIC REOPERATIONS AFTER FAILED AND COMPLICATED ANTIREFLUX OPERATIONS

Nineteen patients underwent laparoscopic reoperations for failed or co mplicated antireflux operations from a total of 248 patients with gast roesophageal reflux disease who had been operated on by this approach. Sixteen had been submitted to open surgery and three to laparoscopic surgery over a period ranging from 5 days to 31 years before the study . Three patients had been submitted to two open antireflux surgeries p reviously. Seventeen patients had recurrent reflux esophagitis after d ifferent types of surgeries, and two patients presented with gastric s trangulation after fundoplication. The causes of recurrence were: slip ped total fundoplications (3), disruption of total and partial fundopl ications (6), too-tight total fundoplication (1), too-low (gastric) pa rtial fundoplication (1), Allison procedure (1), partial fundoplicatio n and paraesophageal hernia (2), and unknown (3). The laparoscopic app roach was used in 18 patients and a laparoscopic-thoracoscopic approac h in 1. The procedures included laparoscopic total fundoplications (11 ), partial fundoplications (4), transhiatal esophagectomy (1), Collis- Nissen (1), Roux-en-Y gastrectomy and thoracoscopic vagotomy (1), and intrathoracic fundoplication (1). One patient was converted to open su rgery. Intraoperative complications included 1 pneumothorax, 1 gastric perforation, and 1 esophageal perforation during the introduction of a Maloney dilator. Mean operative time was 210 min, ranging from 140 t o 320 min. Mean hospital stay was 3.1 days after treatment of failed o perations and 22 days after treatment of complications. Postoperative complications included subcutaneous infection (1), gastric fistula (1) , and liver hematoma (1). The results have been excellent and good in 84.3% of the patients after a mean follow-up of 13 months. We conclude d that laparoscopic reoperations are technically feasible with good pr eliminary results provided that the mandatory expertise is available.