Surgical treatment for recurrent gastro-oesophageal reflux disease after failed antireflux surgery

Background: Recurrent or persistent symptoms occur in 10-15 per cent of pat ients after antireflux surgery. Failure of surgery is not uniform in its pr esentation. The cause of failure is not easily detected and even harder to treat. Different approaches have been proposed and few reports are availabl e on the objective and subjective outcome of reoperation. Methods: This study focuses on 30 patients (16 men and 14 women; age range 20-69 years) with recurrent symptomatic gastro-oesophageal reflux disease ( GORD) resistant to medical treatment. In all patients reoperation was by th e Belsey Mark IV antireflux operation. A clinical history, endoscopy and oe sophageal manometry were obtained in all patients, and 24-h pH monitoring w as performed in 27 of 30 before and in most patients after the Belsey proce dure. Results: Symptomatic improvement was reported in 24 of 30 patients. Oesopha gitis (present before operation in 19 patients) was cured or remained absen t in 24 of 30 patients, stabilized in one, improved in four and deteriorate d in one. Relief of symptoms combined with absence of oesophagitis was obta ined in 21 of 30 patients, with concomitant normalization of the 24-h pH pr ofile in 11 of 22 patients. The median basal lower oesophageal sphincter (L OS) pressure increased significantly from 6.9 to 9.0 mmHg (P < 0.01). Redo surgery had no effect on oesophageal body motility. Conclusion: Reoperation performed for documented recurrent GORD had a good and lasting effect on symptoms, on oesophagitis (both in 24 of 30 patients) and on the combination of both (21 of 30). In these patients reoperation i ncreased basal LOS pressure and decreased reflux time. Overall, the results approximate to those of primary operation.