ESOPHAGECTOMY FOR UNSUCCESSFUL ANTIREFLUX OPERATIONS

Background: Primary antireflux surgery provides excellent symptom reli ef in most patients. Unfortunately, the results of redo surgery are le ss predictable, In these patients, esophageal injury from long-standin g reflux of gastric contents and operative trauma from previous failed antireflux procedures results in progressive deterioration in esophag eal propulsion, poor clearance of reflux episodes, mucosal damage, and , in some cases, stricture formation, For the past 16 years, we have s electively used esophageal resection and replacement instead of anothe r reoperation in these challenging patients, Methods: Seventeen patien ts with end-stage esophageal body dysfunction and one or more previous ly unsuccessful antireflux procedures underwent esophagectomy and reco nstruction by colon interposition in 15 patients and jejunum interposi tion in 2 patients, The indications for esophagectomy rather than a re do antireflux procedure were a global loss of effective esophageal mot ility in 13 and a nondilatable stricture in four, Their outcome was co mpared with that of 32 patients with adequate motility and 18 with a s imilar global loss of motility who had a redo antireflux procedure, Pe rioperative complications after esophagectomy were recorded, and long- term outcome was assessed by means of a standardized questionnaire at a median of 7 years after the operation. Results: Patients with profou nd esophageal body dysfunction who underwent esophageal resection had outcomes similar to those with normal motility who underwent a redo an tireflux procedure, Those with profound esophageal motility dysfunctio n who underwent a redo antireflux procedure had a,verse outcome than t hose who underwent resection, Esophageal resection and replacement was performed without mortality or graft failure, All patients who underw ent resection stated that their preoperative symptoms were relieved co mpletely (n = 6) or improved (n = 10). Thirteen patients (81%) were ab le to eat three meals a day, and 12 patients (75%) enjoyed an unrestri cted diet. Two thirds of the patients were at or above their ideal bod y weight, and 88% were fully satisfied dth the outcome of the procedur e. Conclusion: Patients with end-stage esophageal body dysfunction who have had a previous unsuccessful antireflux procedure can be treated by esophageal resection with a high expectation of success.