COMPLICATIONS OF ANTIREFLUX SURGERY

In order to determine the in-hospital morbidity and mortality rates of antireflux surgery in a community hospital setting, a retrospective 1 0-year review of 355 antireflux procedures was conducted. A modified N issen fundoplication, with an incomplete fundal wrap, was the most com mon operation performed. Concomitant procedures, usually biliary or ga stric, were undertaken in 93 patients. Thirty-nine patients had previo usly undergone an operation involving hiatal dissection. Overall morbi dity was 17%, and mortality was 1% (three deaths). Patients with previ ous hiatal surgery had higher morbidity (44%, p <0.0001) and mortality rates (3%, p <0.21). Wound infection occurred in 5% of patients and w ound dehiscence in 1%. Splenic repair or splenectomy for iatrogenic in jury was required in 2%. Postoperative gastroesophageal leaks occurred in six patients (2%). Patients with previous hiatal surgery had a hig her incidence of gastroesophageal leaks (8%, p <0.002). Three of six p atients had contained leaks that resolved with antibiotics, cessation of oral intake, and nutritional support. Two of three patients with no ncontained leaks died despite surgical intervention.