Adverse Outcomes and Failure Following Laparoscopic Antireflux Surgery
Despite the fact that the majority of patients who undergo laparoscopic antireflux surgery have a good or excellent clinical outcome, a small proportion of patients develop a significant complication, side effect or recurrent reflux during postoperative followup. The management of these patients is complex. If problems occur in the immediate post-operative period, then early laparoscopic re-exploration should be considered, as many problems are easily be corrected within a week of the original procedure.
Patients who develop problems during later followup should be fully reinvestigated, and non-operative treatment options are initially recommended, as many of the early side effects resolve with conservative management. Endoscopy and dilatation can be helpful at this stage. If problems persist beyond 12 months, then reoperation can be considered in patients with persistent dysphagia, symptomatic recurrent hiatus hernia, or recurrent reflux which is poorly controlled with medication. However, further surgery is unlikely to be help patients with persistent “wind-related” side effects.
KeywordsLaparoscopic Fundoplication Partial Fundoplication Esophageal Hiatus Laparoscopic Antireflux Surgery Persistent Dysphagia
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- Watson DI, Mathew G, Pike GK, Jamieson GG (1997) Comparison of anterior, posterior and total fundoplication using a viscera model. Dis Esoph 10: 110–114Google Scholar
- Watson DI, Jamieson GG, Lally C, Archer S, Bessell JR, Booth M, Cade R, Cullingford G, Devitt PG, Fletcher DR, Hurley J, Kiroff G, Martin C, Martin IJG, Nathanson LK, Windsor J (2004) Multicentre prospective double blind randomized trial of laparoscopic Nissen versus anterior 90 degree partial fundoplication. Arch Surg 139: 1160–1167PubMedCrossRefGoogle Scholar