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Long-term results after laparoscopic revision fundoplication: a retrospective, single-center analysis in 194 patients with recurrent hiatal hernia

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Abstract

Background

After laparoscopic fundoplication, 10–20% of patients experience symptom recurrence—often due to resurgence of the hiatal hernia. The standard surgical treatment for such cases remains laparoscopic revision fundoplication. However, there is little data on the time frame and anatomic patterns of failed fundoplications. Additionally, few large studies exist on the long-term efficacy and safety of laparoscopic revision fundoplication.

Methods

In a single-center, retrospective analysis of 194 consecutive revision fundoplications for recurrent reflux disease due to hiatal hernia, we collected data on time to failure and patterns of failure of the primary operation, as well as on the efficacy and safety of the revision.

Results

The median time to failure of the primary fundoplication was 3 years. Most hiatal defects were smaller than 5 cm and located anteriorly or concentric around the esophagus. Laparoscopic redo fundoplication was technically successful in all cases. The short-term complication rate was 9%, mainly dysphagia requiring endoscopic intervention. At a mean follow-up of 4.7 years, 77% of patients were symptom-free, 14% required daily PPI, and 9% underwent secondary revision. Cumulative failure rates were 9%, 23%, and 31% at 1, 5, and 10 years.

Conclusion

The majority of failed fundoplications occur within 3 years of primary surgery, with most patients exhibiting anterior or concentric defects. For these patients, laparoscopic revision fundoplication is a safe procedure with a low rate of short-term complications and satisfactory long-term results.

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Funding

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Surgery, MIC Klinik, Kurstr. 11, 14129, Berlin, Germany

    Björn Siemssen & Marius Jonathan Ibach

  2. Medizinische Hochschule Brandenburg, Zentrum für Innere Medizin Universitätsklinikum Brandenburg an der Havel, Brandenburg, Germany

    Florian Hentschel

Authors
  1. Björn Siemssen
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  2. Florian Hentschel
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Contributions

All authors contributed to the study’s conception and design. Björn Siemssen and Marius Ibach performed material preparation, data collection, and analysis. Marius Ibach wrote the first draft of the manuscript, and all authors commented on previous versions of the manuscript. All authors—Björn Siemssen, Florian Hentschel, and Marius Ibach—read and approved the final manuscript.

Corresponding author

Correspondence to Björn Siemssen.

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Ethical Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Dr. Ibach, Dr. Siemssen, and Dr. Hentschel declare that they have no conflict of interest.

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Informed consent was obtained from all individual participants included in the study.

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Siemssen, B., Hentschel, F. & Ibach, M.J. Long-term results after laparoscopic revision fundoplication: a retrospective, single-center analysis in 194 patients with recurrent hiatal hernia. Esophagus (2024). https://doi.org/10.1007/s10388-024-01060-0

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