REOPERATION AFTER FAILED ANTIREFLUX SURGERY

Between 1978 and 1992, 61 patients were operated on for new or recurre nt problems after antireflux surgery. Indications for reoperation were recurrent reflux in 50 patients (associated with dysphagia in 14), dy sphagia alone in six and postprandial pain in five. At reoperation the cause of the problem was apparent as anatomical breakdown of the repa ir in 19 patients, gastric pull-through (slipped Nissen procedure) in 14 and paraoesophageal hernia in six. In 18 patients the cause of the symptoms was not readily apparent. Reoperation consisted of fundoplica tion alone in 27 patients, fundoplication with pyloroplasty in eight, fundoplication with proximal gastric vagotomy in four, a Collis-Nissen procedure in 11 (four also had pyloroplasty), a Roux-en-Y procedure i n four, total gastrectomy in one and reduction of a paraoesophageal he rnia in six. Of the 20 patients with some form of destruction of the g astric outlet six experienced troublesome dumping symptoms and in two this was severe. Two patients died from cardiac causes after surgery. Of the remaining 59 patients, 51 rated the procedure as successful. Re peat antireflux procedures can give results almost as good as those of primary antireflux surgery. However, pyloroplasty and gastric resecti on should be avoided if at all possible.