CLINICAL, RADIOLOGICAL AND FUNCTIONAL RESULTS OF REMEDIAL ANTIREFLUX OPERATIONS

Fifty-five patients were reoperated on for an unsatisfactory outcome a fter antireflux surgery. Presenting symptoms were heartburn alone (27) , heartburn and dysphagia (10), dysphagia alone (9), chest pain (4), l eft shoulder pain (1), left shoulder pain and fever (1), and signs of anemia (3). The symptom of dysphagia was usually of immediate onset wh ereas heartburn reoccurred after a symptom-free period (p = 0.014). Th e most common failed antireflux procedure was a Nissen fundoplication (37). The incompleteness of the residual wrap, its location around the stomach and the irreducibility of the gastro-oesophageal junction bel ow the diaphragm were accurately predicted by barium swallow study in 70, 83 and 92% of the patients, respectively. Abnormal oesophageal bod y motility was related to oesophagitis, herniation of the residual rep air into the chest or both (16/20), and it normalized in 6 of the 11 p atients evaluated at follow-up. Oesophageal acid exposure and prevalen ce of oesophagitis were higher in patients with heartburn than in thos e with other symptoms (p < 0.02). Intraoperative findings were breakdo wn of the repair, its location around the stomach, its herniation into the chest, its too excessive tightness, a gastric fistula, or any com bination. Remedial surgery consisted of a new antireflux procedure (42 ), a new antireflux procedure combined with closure of a gastric fistu la (3), a closure of a gastric fistula alone (1), a closure of the cru ra (4), an oesophageal resection (3), a total gastrectomy (1), and a d uodenal diversion (1). Postoperative mortality and morbidity were 5.4 and 23.4%, respectively. At follow-up (range: 3 to 160 months), clinic al, radiological and pH-monitoring success rates were 89.1, 85.7 and 8 8.4%, respectively.