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Reoperative Anti-Reflux Surgery and Revisional Paraesophageal Hernias

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Revisional Foregut Surgery

Abstract

With growing concern over the side effects of long-term proton pump inhibitor use, the surgical management of reflux disease has recently become increasingly popular, especially with the development of the laparoscopic approach. Anti-reflux surgery and paraesophageal hernia repair require technical expertise. These operations have a known failure rate over time, and many patients will go on to require a subsequent intervention. Patients with development of new symptoms after surgery or worsening symptoms should be evaluated for a revisional operation. The workup of these patients can often guide management and surgical planning and may aid in identifying patients that will respond to medical therapy. Once the decision is made to take the patient to the operating room, reoperative surgery can present challenges with difficult dissection and alterations in anatomy. Essential operative steps should include efforts to restore “normal” anatomy, which can include taking down the fundoplication and cruroplasty, evaluation for a short esophagus, recreating the fundoplication, posterior cruroplasty with or without biologic mesh reinforcement, and intraoperative endoscopy. The following chapter will detail the workup for a patient being evaluated for revisional anti-reflux surgery or a patient with a recurrent paraesophageal hernia, as well as essential operative steps and outcomes.

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Authors and Affiliations

  1. Monmouth Medical Center, Director of Minimally Invasive Surgery, Long Branch, NJ, USA

    Frank J. Borao

  2. Monmouth Medical Center, Department of Surgery, Long Branch, NJ, USA

    Brian J. Shea, Shabiah C. Martin & Jonathan M. Decker

  3. Monmouth Medical Center, Department of Thoracic Surgery, Long Branch, NJ, USA

    Anthony J. Squillaro

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  1. Monmouth Medical Center, Long Branch, NJ, USA

    Frank J. Borao

  2. Monmouth Medical Center, Long Branch, NJ, USA

    Steven J. Binenbaum

  3. Monmouth Medical Center, Long Branch, NJ, USA

    Gurdeep S. Matharoo

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Borao, F.J., Shea, B.J., Martin, S.C., Decker, J.M., Squillaro, A.J. (2020). Reoperative Anti-Reflux Surgery and Revisional Paraesophageal Hernias. In: Borao, F., Binenbaum, S., Matharoo, G. (eds) Revisional Foregut Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-28273-8_9

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