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Roux-en-Y reconstruction is superior to redo fundoplication in a subset of patients with failed antireflux surgery

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Abstract

Background

A subset of patients requires reoperative antireflux surgery (Re-ARS) after failed fundoplication. The aim of this study was to determine symptomatic outcomes beyond 1 year following Re-ARS and to assess the relative utility of two different surgical approaches.

Methods

After Institutional Review Board approval, patients who underwent Re-ARS were identified from a prospective database. Symptom severity was graded on a 0–3 scale. Patients with postoperative symptoms of grade ≥2 were considered to have a poor outcome. Patient satisfaction was graded using a 10-point visual analog scale.

Results

At least 1 year of follow-up was available for 130 patients. There were 94 redo fundoplications (RF) and 36 Roux-en-Y reconstructions (RNYR). Symptom risk factors (significant preoperative dysphagia, significant preoperative heartburn, esophageal dysmotility, short esophagus, delayed gastric emptying, multiple failed hiatal surgeries, reflux-related respiratory symptoms) were more prevalent in patients who underwent RNYR compared to RF (mean 3.0 vs. 2.2; p = 0.003). Postoperative leaks and major complications occurred in 4.5 % (5/110) versus 0% and 21.6 % versus 33.3 % of the RF and RNYR groups, respectively. Twenty-eight RF patients (29.8 %) and 9 RNYR patients (25.0 %) reported poor outcomes. Among patients with ≥4 risk factors, those who underwent RNYR had a lower incidence of poor outcome (7.7 % vs. 55 %, p = 0.018) and higher satisfaction scores (8.4 vs. 5.8, p = 0.001) compared to those who had RF. Overall, 85 % of patients were satisfied or highly satisfied with their results and the average satisfaction score was 8.2.

Conclusion

Re-ARS provides good subjective outcomes when measured more than 1 year after surgery. Patients with more complex pathology benefit more from RNYR despite the higher postoperative complication rate. This is especially true for patients with decreased esophageal motility and short esophagus.

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Disclosures

Drs. Sumeet K. Mittal, Andras Legner, Kazuto Tsuboi, Arpad Juhasz, Lokesh Bathla, and Tommy H. Lee have no conflict of interest or financial ties to disclose.

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Authors and Affiliations

  1. Department of Surgery, Creighton University Medical Center, Creighton University School of Medicine, 601 North 30th Street, Suite 3700, Omaha, NE, 68131, USA

    Sumeet K. Mittal, András Légner, Kazuto Tsuboi, Arpad Juhasz, Lokesh Bathla & Tommy H. Lee

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  1. Sumeet K. Mittal
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  2. András Légner
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  3. Kazuto Tsuboi
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Correspondence to Sumeet K. Mittal.

Appendix

Appendix

See Table 6.

Table 6 Appendix follow-up questionnaire
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Mittal, S.K., Légner, A., Tsuboi, K. et al. Roux-en-Y reconstruction is superior to redo fundoplication in a subset of patients with failed antireflux surgery. Surg Endosc 27, 927–935 (2013). https://doi.org/10.1007/s00464-012-2537-4

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