Laparoscopic refundoplications after failed antireflux surgery

BACKGROUND: Open and laparoscopic antireflux procedures may require reopera tion for failures of the initial procedure in about 3% to 6% of cases. The purpose of this study is to describe our operative experiences, postoperati ve results, and patients' view of outcome following laparoscopic refundopli cation. METHODS: Thirty patients (18 men, 12 women), mean age 56 years (range 37 to 77) underwent laparoscopic redo surgery. In 18 patients the initial surger y was done by the open technique, and 3 had surgery twice previously. Twelv e patients had previous laparoscopic antireflux surgery. Indications for re do surgery were recurrent reflux (n = 17), dysphagia (n = 6), and the combi nation of both (n = 7), RESULTS: Twenty-eight patients were completed laparoscopically, 21 with a f loppy Nissen and 7 with a Toupet fundoplication. Two patients were converte d to the open procedure because of intraoperative technical problems. In 5 cases there was an injury to the stomach wall, successfully managed laparos copically, Postoperatively 1 patient had dysphagia and required pneumatic d ilatation, another had gas bloat. There was a significant increase in lower esophageal sphincter pressure at 3 months (12.4 +/- 4.8 mm Hg; n = 30) and 1 year (12.3 +/- 4.5 mm Hg; n = 30), Twenty-four hour pH monitoring showed a decrease of the DeMeester Score at 3 months after surgery from 14.7 +/- 10.6 (n = 30) and 1 year after surgery from 12.1 +/- 8.7 (n = 30), Gastroin testinal quality of life index increased from 87 points preoperatively to 1 21 at 3 months and 123 at 1 year, which is comparable with a healthy popula tion (123 points). CONCLUSIONS: Laparoscopic refundoplication is a feasible and effective proc edure with excellent postoperative results, independent of whether the prim ary procedure was done by the open or laparoscopic technique. Am J Surg. 19 99;178: 541-544. (C) 1999 by Excerpta Medica, Inc.