REFUNDOPLICATION FOR RECURRENT GASTROESOPHAGEAL REFLUX

Reoperation after a failed antireflux procedure is a surgical challeng e. Many operative techniques have been proposed, but reports on system atic follow-up with endoscopy and esophageal function tests are few. T he purpose of the present study was to evaluate the results of repeate d fundoplication in cases of recurrent reflux, including assessment of esophageal function. Of the 18 cases of repeat fundoplication perform ed for recurrent reflux during 1970-1991 at Tampere University Hospita l, 15 were evaluated a median of 18 (range 5-152) months after reopera tion. Follow-up studies included endoscopy in all and esophageal funct ion tests (esophageal 24-hour pH recording, manometry, and radionuclid e transit) in 14 cases. All the patients had defective fundic wrap bef ore reoperation, whereas at follow-up 12 of the 15 wraps were intact. Reflux symptoms were diminished in all 15. Six patients (40%), however , had objective recurrence of reflux (esophagitis or pathologic pH rec ording). Three of the recurrences were due to slipped fundic wrap, but the others were probably caused by impaired esophageal function. By r epeat fundoplication the wrap could be repaired as reliably as in prim ary operation. Symptomatic outcome and objective results were reasonab le. The results were, however, not as good as after primary operation, which was due to more impaired esophageal motility caused by prolonge d reflux or repeated surgery (or both).