Adverse Outcomes and Failure Following Laparoscopic Antireflux Surgery

  • D. I. Watson


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.


Laparoscopic Fundoplication Partial Fundoplication Esophageal Hiatus Laparoscopic Antireflux Surgery Persistent Dysphagia 
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  1. [1]
    Lafullarde T, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2001) Laparoscopic Nissen fundoplication — 5 year results and beyond. Arch Surg 136: 180–184PubMedCrossRefGoogle Scholar
  2. [2]
    Nilsson G, Wenner J, Larsson S, Johnsson F (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-esophageal reflux. Br J Surg 91: 552–559PubMedCrossRefGoogle Scholar
  3. [3]
    Ludemann R, Watson DI, Game PA, Devitt PG, Jamieson GG (2005) Laparoscopic total versus anterior 180° fundoplication — five year follow-up of a prospective randomized trial. Br J Surg 92: 240–243PubMedCrossRefGoogle Scholar
  4. [4]
    Yau P, Watson DI, Devitt PG, Game PA, Jamieson GG (2000) Early reoperation following laparoscopic antireflux surgery. Am J Surg 179: 172–176PubMedCrossRefGoogle Scholar
  5. [5]
    Lundell L, Abrahamsson H, Ruth M, Rydberg L, Lonroth H, Olbe L (1996) Long-term results of a prospective randomized comparison of total fundic wrap (Nissen-Rossetti) or semifundoplication (Toupet) for gastro-esophageal reflux. Br J Surg 83: 830–835PubMedGoogle Scholar
  6. [6]
    Coelho JC, Wiederkehr JC, Campos AC, Andrigueto PC (1999) Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease. J Am Coll Surg 189: 356–361PubMedCrossRefGoogle Scholar
  7. [7]
    Collard JM, de Gheldere CA, De Cock M, Otte JB, Kestens PJ (1994) Laparoscopic antireflux surgery. What is real progress? Ann Surg 220: 146–154PubMedGoogle Scholar
  8. [8]
    Gotley DC, Smithers BM, Rhodes M, Menzies B, Branicki FJ, Nathanson L (1996) Laparoscopic Nissen fundoplication — 200 consecutive cases. Gut 38: 487–491PubMedGoogle Scholar
  9. [9]
    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: 472–483PubMedGoogle Scholar
  10. [10]
    Watson DI, Jamieson GG, Devitt PG, Mitchell PC, Game PA (1995) Paraoesophageal hiatus hernia: an important complication of laparoscopic Nissen fundoplication. Br J Surg 82: 521–523PubMedGoogle Scholar
  11. [11]
    Joris JL, Chiche J-D, Lamy ML (1995) Pneumothorax during laparoscopic fundoplication: diagnosis and treatment with positive end-expiratory pressure. Anesth Analg 81: 993–1000PubMedCrossRefGoogle Scholar
  12. [12]
    Watson DI, Jamieson GG, Devitt PG, Kennedy A, Ellis T, Ackroyd R, Lafullarde T, Game PA (2001) A prospective randomized trial of laparoscopic Nissen fundoplication with anterior versus posterior hiatal repair. Arch Surg 136: 745–751PubMedCrossRefGoogle Scholar
  13. [13]
    Leeder PC, Smith G, Dehn TC (2003) Laparoscopic management of large paraesophageal hiatal hernia. Surg Endosc 17: 1372–1375PubMedCrossRefGoogle Scholar
  14. [14]
    Patterson EJ, Herron DM, Hansen PD, Ramzi N, Standage BA, Swanstrom LL (2000) Effect of an esophageal bougie on the incidence of dysphagia following Nissen fundoplication: a prospective, blinded, randomized clinical trial. Arch Surg 135: 1055–1061PubMedCrossRefGoogle Scholar
  15. [15]
    Jamieson GG, Watson DI, Britten-Jones R, Mitchell PC, Anvari M (1994) Laparoscopic Nissen fundoplication. Ann Surg 220: 137–145PubMedGoogle Scholar
  16. [16]
    Collet D, Cadiere GB (1995) Conversions and complications of laparoscopic treatment of gastroesophageal reflux disease. Am J Surg 169: 622–626PubMedCrossRefGoogle Scholar
  17. [17]
    Schauer PR, Meyers WC, Eubanks S, Norem RF, Franklin M, Pappas TN (1996) Mechanisms of gastric and esophageal perforations during laparoscopic Nissen fundoplication. Ann Surg 223: 43–52PubMedCrossRefGoogle Scholar
  18. [18]
    Cadiere GB, Himpens J, Bruyns J (1995) How to avoid esophageal perforation while performing laparoscopic dissection of the hiatus. Surg Endosc 9: 450–452PubMedGoogle Scholar
  19. [19]
    O’Boyle CJ, Watson DI, Jamieson GG, Myers JC, Game PA, Devitt PG (2002) Division of short gastric vessels at laparoscopic Nissen fundoplication — a prospective double blind randomized trial with five year follow-up. Ann Surg 235: 165–170PubMedCrossRefGoogle Scholar
  20. [20]
    Hagedorn C, Lonroth H, Rydberg L, Ruth M, Lundell L (2002) Long-term efficacy of total (Nissen-Rossetti) and posterior partial (Toupet) fundoplication: results of a randomized clinical trial. J Gastrointest Surg 6: 540–545PubMedCrossRefGoogle Scholar
  21. [21]
    Luostarinen M, Isolauri J, Laitinen J, Koskinen M, Keyrilainen O, Markkula H, Lehtinen E, Uusitalo A (1993) Fate of Nissen fundoplication after 20 years. A clinical, endoscopical, and functional analysis. Gut 34: 1015–1020PubMedGoogle Scholar
  22. [22]
    Allison PR (1973) Hiatus hernia: a 20-year retrospective survey. Ann Surg 178: 273–276PubMedGoogle Scholar
  23. [23]
    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
  24. [24]
    Rieger NA, Jamieson GG, Britten-Jones R, Tew S (1994) Reoperation after failed antireflux surgery. Br J Surg 81: 1159–1161PubMedGoogle Scholar
  25. [25]
    Watson DI, Jamieson GG, Game PA, Williams RS, Devitt PG (1999) Laparoscopic reoperation following failed antireflux surgery. Br J Surg 86: 98–101PubMedCrossRefGoogle Scholar
  26. [26]
    Curet MJ, Josloff RK, Schoeb O, Zucker KA (1999) Laparoscopic reoperation for failed antireflux procedures. Arch Surg 134: 559–563PubMedCrossRefGoogle Scholar
  27. [27]
    Ackroyd R, Watson DI, Majeed AW, Troy G, Treacy PJ, Stoddard CJ (2004) Randomized clinical trial of laparoscopic versus open fundoplication for gastro-esophageal reflux disease. Br J Surg 91: 975–982PubMedCrossRefGoogle Scholar
  28. [28]
    Watson DI, Pike GK, Baigrie RJ, Mathew M, Devitt PG, Britten-Jones R, Jamieson GG (1997) Prospective double blind randomized trial of laparoscopic Nissen fundoplication with division and without division of short gastric vessels. Ann Surg 226: 642–652PubMedCrossRefGoogle Scholar
  29. [29]
    Watson DI, Jamieson GG, Pike GK, Davies N, Richardson M, Devitt PG (1999) A prospective randomized double blind trial between laparoscopic Nissen fundoplication and anterior partial fundoplication. Br J Surg 86: 123–130PubMedCrossRefGoogle Scholar
  30. [30]
    Watson DI, Liu JF, Devitt PG, Game PA, Jamieson GG (2000) Outcome of laparoscopic anterior 180 degree partial fundoplication for gastro-esophageal reflux disease. J Gastrointest Surg 4: 486–492PubMedCrossRefGoogle Scholar
  31. [31]
    Watson DI, Jamieson GG, Mitchell PC, Devitt PG, Britten-Jones R (1995) Stenosis of the esophageal hiatus following laparoscopic fundoplication. Arch Surg 130: 1014–1016PubMedGoogle Scholar
  32. [32]
    Hashemi M, Peters JH, DeMeester TR, Huprich JE, Quek M, Hagen JA, Crookes PF, Theisen J, DeMeester SR, Sillin LF, Bremner CG (2000) Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg 190: 553–560PubMedCrossRefGoogle Scholar
  33. [33]
    Aly A, Munt J, Jamieson GG, Gabb M, Ludemann R, Devitt PG, Watson DI (2005) Large hiatal hernia: recurrence after laparoscopic repair. Br J Surg 92: 648–653PubMedCrossRefGoogle Scholar
  34. [34]
    Jobe BA, Aye RW, Deveney CW, Domreis JS, Hill LD (2002) Laparoscopic management of giant type III hiatal hernia and short esophagus. Objective follow-up at three years. J Gastrointest Surg 6: 181–188PubMedCrossRefGoogle Scholar
  35. [35]
    Carlson MA, Richards CG, Frantzides CT (1999) Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy. Dig Surg 16: 407–410PubMedCrossRefGoogle Scholar
  36. [36]
    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
  37. [37]
    Hagedorn C, Jonson C, Lonroth H, Ruth M, Thune A, Lundell L (2003) Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, controlled clinical trial. Ann Surg 238: 189–196PubMedCrossRefGoogle Scholar
  38. [38]
    de Beaux A, Watson DI, O’Boyle C, Jamieson GG (2001) Role of fundoplication in patient symptomatology after laparoscopic antireflux surgery. Br J Surg 88: 1117–1121PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag/Wien 2006

Authors and Affiliations

  • D. I. Watson
    • 1
    • 2
    • 3
  1. 1.Department of SurgeryFlinders UniversitySouth Australia, Australia
  2. 2.Flinders Medical CentreSouth Australia, Australia
  3. 3.Hepatobiliary and Oesophagogastric Surgical UnitFlinders Medical CentreSouth Australia, Australia

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