REOPERATIONS AFTER FAILED ANTIREFLUX PROCEDURES

With the advent of laparoscopic surgery, the number of anti-reflux pro cedures performed has virtually exploded in some centers. Persistent, recurrent or new symptoms after an antireflux procedure are therefore likely to become a more common problem in the near future. Recurrent r eflux is usually due to a breakdown of the repair and can frequently b e treated medically or by a repeat antireflux procedure. In contrast, postoperative dysphagia, with or without accompanying reflux symptoms, may be due to a myriad of causes which include a slipped wrap, a wrap that has been placed around the stomach rather than the esophagus, a wrap which is either too tight or too long, the development of a stric ture, the presence of a motor disorder of the esophageal body, or a co mbination of these factors. These situations can not usually be solved by a simple redo fundoplication or medications. Rather, the successfu l management of these patients requires an individual therapeutic appr oach, based on the presenting symptom or symptom constellation, the re sults of function tests and the intraoperative findings. The surgeon c aring for patients with failed antireflux procedures should be intimat ely acquainted with the whole spectrum of revisional, resective and re constructive procedures of the stomach, cardia, and esophagus.