GASTROESOPHAGEAL REFLUX - REOPERATIONS VI A AN TRANSABDOMINAL APPROACH

One to five percent of patients who have undergone antireflux operatio n will be reoperated on for severe persistent or recurrent symptoms. M ost cases of failed operation are observed after Nissen fundoplication : partially or totally disrupted fundic wrap, slipping of the fundopli cation, perigastric wrapping, gastric paraoesophageal hernia. Preopera tive functional tests, including manometry, can identify the factors r esponsible for failure of the initial operation and guide the choice f or remedial surgery. A review of the literature shows that the results at reoperation are not as good as those at the primary procedure : mo rtality is 0 to 12 %, morbidity 7 to 57 %, good functional results 75 to 96 %. In conclusion : remedial surgery is possible through a transa bdominal approach at the first operation. Redo-fundoplication is recom mended. Nissen or Collis-Nissen procedure is the most frequently perfo rmed. Results are directly related to the number of previous operation s.