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Causes of Failures After Antireflux Surgery and Indication, Technique and Results of Laparoscopic Redo-Antireflux Procedures

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Management of Gastroesophageal Reflux Disease

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Abstract

After the “boom” of laparoscopic antireflux surgery in the past 25 years, the necessity of revisional surgery (redo-surgery) has also increased. It can be anticipated from large series that the average overall necessity of redo-antireflux surgery is around 5% (5–60%) The failure after antireflux surgery can be defined as persisting, recurrent, or new onset of troublesome symptoms after the primary procedure or by results of objective testing. Reasons for failures are partial or complete loss of the antireflux barrier, a new-onset dysphagia combined with or without reflux problems due to an incorrectly placed wrap, a slipped wrap, or dysphagia due to a peptic stenosis caused by reflux recurrence or a compression of the distal esophagus by paraesophageal herniation, as well as epigastric pain, cramps, and/or nausea and vomiting by gastroparesis. Insufficient, preoperative diagnostic workup and neglecting important pathophysiologic factors that should have influenced the decision for surgery could also be a major cause of failure. A superficial approach necessary for diagnostic evaluations of the patient and a superficial process of therapeutic decision-making will lead to inappropriate selection of patients. Most frequent problems are migration of the wrap and mediastinal dislocation, a partial or complete breakdown of the wrap, a short esophagus, a slippage of the wrap, and other anatomical changes. The failure rate after redo-antireflux surgery lies between 15% and 25%. This underlines the importance to have at least the redo-surgery done in a dedicated esophageal center.

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Authors and Affiliations

  1. University of California San Diego, Center for the Future of Surgery, La Jolla, CA, USA

    Karl-Hermann Fuchs

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  1. University of California, San Diego, Center for the Future of Surgery, La Jolla, CA, USA

    Santiago Horgan

  2. University of California, San Diego, Center for the Future of Surgery, La Jolla, CA, USA

    Karl-Hermann Fuchs

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Fuchs, KH. (2020). Causes of Failures After Antireflux Surgery and Indication, Technique and Results of Laparoscopic Redo-Antireflux Procedures. In: Horgan, S., Fuchs, KH. (eds) Management of Gastroesophageal Reflux Disease. Springer, Cham. https://doi.org/10.1007/978-3-030-48009-7_17

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  • DOI: https://doi.org/10.1007/978-3-030-48009-7_17

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