Early reoperation following laparoscopic antireflux surgery

PURPOSE: TO assess the outcome for patients undergoing early reoperation fo llowing laparoscopic antireflux surgery. METHODS: The outcome was prospectively determined for 28 patients who under went 30 reoperative procedures within 4 weeks of their initial laparoscopic fundoplication between 1992 and 1998, Follow-up ranged from 3 months to 4 years (median 2 years). Before mid 1994, patients were assessed and managed based on clinical findings (first 192 patients in overall series), whereas subsequently (for the most recent 530 patients) all patients underwent rou tine early postoperative barium swallow radiography, and laparoscopic explo ration during the first postoperative week if problems were suspected. RESULTS: The reoperations were performed for acute paraoesophageal hiatus h ernia (8 patients), tight oesophageal hiatus (7), postoperative haemorrhage (3), tight Nissen fundoplication (8), early recurrent reflux (1), and coel iac/superior mesenteric artery thrombosis (1), Two patients required a seco nd operation for persistent dysphagia due to a tight hiatus. Both patients initially underwent loosening of their fundoplication, Before mid 1994, reo perations were usually undertaken by an open approach, whereas subsequently a laparoscopic approach has usually been successful. Laparoscopic reinterv ention was easily achieved within 7 days of the first procedure whereas sub sequent surgery was more difficult and often required open surgery. The cha nge in protocol was associated with an improvement in overall patient satis faction and dysphagia in the latter part of this experience. CONCLUSIONS: Routine early contrast radiology following laparoscopic fundop lication and a low threshold for laparoscopic reexploration facilitates ear ly identification of postoperative problems at a time when laparoscopic cor rection is easily achieved. This may result in an improved overall outcome for patients requiring early reintervention following laparoscopic antirefl ux surgery. (C) 2000 by Excerpta Medica, Inc.