Abstract
Background: Three factors determine the successful outcome after an antireflux operation for gastroesophageal reflux disease (GERD): indication for surgery, choice of the operative procedure, and quality of the operation. Laparoscopic treatment has not changed these concepts. The factor most likely to have been modified is the technical quality of the operative procedure. We evaluated 26 patients presenting with failure after laparoscopic antireflux surgery to determine the causes.
Methods: Nineteen patients came from our series of 503 laparoscopic antireflux procedures and seven patients were referred from other centers. Preoperative, peroperative, and postoperative data were retrospectively reviewed to analyze the responsible factor(s).
Results: Nine patients presented with a sphincter mechanism failure to control reflux, 14 patients had severe dysphagia, 3 patients presented with severe epigastric pain. The first operation was a Nissen-Rossetti fundoplication in 17 patients. The technical quality of the operative procedure was the responsible factor in 22/26 patients. The choice of the type of operation was questionable in five patients. Eight patients underwent successful endoscopic treatment, reoperation was necessary in 10 patients. Four patients underwent medical therapy, and four patients had no treatment.
Conclusions: The laparoscopic Nissen-Rossetti fundoplication was associated with a higher rate of failures, in terms of recurrent disease or severe dysphagia. The use of this technique was related to the laparoscopic inexperience of the surgeon, leading to a wrong application of the original procedure. Partial posterior fundoplication and total fundoplication with division of the short gastric vessels are obviously associated with a better outcome, if the selection of the operation is based on a strict preoperative physiopathological evaluation of the disease.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Ancona E, Zaninotto G, Constantini M, Merigliano S, Baessato M, Peracchia A (1988) Reoperations after complications or failures of antireflux surgery: diagnosis and treatment. Dis Esophagus 1: 1251–1254
Aye RW, Hill LD, Kraemer SJ, Snopkowski P (1994) Early results with the laparoscopic Hill repair. Am J Surg 167: 542–546
Bagnato VJ (1992) Laparoscopic Nissen fundoplication. Surg Laparosc Endosc 2: 188–190
Bittner HB, Meyers WC, Brazer SR, Pappas TN (1994) Laparoscopic Nissen fundoplication: operative results and short term followup. Am J Surg 167: 193–198
Cadiere GB, Houben JJ, Bruyns J, Himpens J, Panzer JM, Gelin M (1994) Laparoscopic Nissen fundoplication: technique and preliminary results. Br J Surg 81: 400–403
Champault G (1994) Gastroesophageal reflux. Treatment by laparoscopy. 940 cases [French experience]. Annal Chir 48: 159–164
Cuschieri A, Hunter J, Wolfe B, Swanstrom LL, Hutson W (1993) Multicenter prospective evaluation of laparoscopic antireflux surgery. Preliminary report. Surg Endosc 7: 505–510
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1991) Laparoscopic Nissen fundoplication. Preliminary report. Surg Laparosc Endosc 1: 138–143
Dallemagne B, P Taziaux, J Weerts, C Jehaes, S Markiewicz (1993) Chirurgie laparoscopique du reflux gastrooesophagien. Ann Chir 49: 30–36
Dallemagne B (1993) Endoscopic approaches to oesophageal disease [Review]. Baillieres Clin Gastroenterol 7(4): 795–822
Dallemagne B, Weerts JM, Jehaes C, Markiewicz S, Lombard R (1993) Techniques and results of endoscopic fundoplication. Endosc Surg Allied Technol 1: 72–75
DeMeester TR, Bonavina L, Albertucci M (1986) Nissen fundoplication for gastroesophageal reflux disease. Evaluation of primary repair in 100 consecutive patients. Ann Surg 204: 9–20
Fuchs KH, Freys SM, Heimbucher J, Thiede A (1993) Experiences with laparoscopic technique in antireflux surgery. Chirurg 64: 317–323
Hinder RA, Filipi CJ, Wetscher G, Neary P, DeMeester TR, Perdikis G (1994) Laparoscopic Nissen fundoplication is an effective treatment for gastroesophageal reflux disease. Ann Surg 220: 472–481
Jamieson GG, Watson DI, BrittenJones R, Mitchell PC, Anvari M (1994) Laparoscopic Nissen fundoplication. Ann Surg 220: 137–145
Lind JF, Burns CM, MacDougall JT (1965) Physiologic repair for hiatus hernia: manometric study. Arch Surg 91: 233–236
O'Reilly MJ, Mullins SG (1993) Laparoscopic Nissen fundoplication: report of first 15 cases. J Laparoendosc Surg 3: 317–324
Rossetti M, Hell K (1977) Fundoplication for the treatment of gastroesophageal reflux in hiatal hernia. World J Surg 1: 439–443
Siewert JR, Feussner H, Walker SJ (1992) Fundoplication: How to Do it? Periesophageal wrapping as a therapeutic principal in gastroesophageal reflux prevention. World J Surg 16: 326–334
Skinner DB (1992) Surgical management after failed antireflux operations. World J Surg 16: 359–363
Toupet A (1963) Technique d'oesophagogastroplastie avec phrénogastropexie appliquée dans la cure radicale des hernies hiatales et comme complément de l'opération de Heller dans les cardiospasmes. Mem Acad Chir 89: 394
Watson A, Jenkinson LR, Ball CS, Barlow AP, Norris TL (1991) A more physiological alternative to total fundoplication for the surgical correction of resistant gastrooesophageal reflux. Br J Surg 78: 1088–1094
Watson DI, Jamiseon GG, Devitt PG, Mitchell PC, Game PA (1995) Paraesophageal hiatus hernia: an important complication of laparoscopic Nissen fundoplication. Br J Surg 82: 521–523
Weerts JM, Dallemagne B, Hamoir E, Demarche M, Markiewicz S, Jehaes C, Lombard R, Demoulin JC, Etienne M, Ferron PE (1993) Laparoscopic Nissen fundoplication: detailed analysis of 132 patients. Surg Laparosc Endosc 3: 359–364
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Dallemagne, B., Weerts, J.M., Jehaes, C. et al. Causes of failures of laparoscopic antireflux operations. Surg Endosc 10, 305–310 (1996). https://doi.org/10.1007/BF00187377
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00187377