Fuchs, K. H., Breithaupt, W., Varga, G., Babic, B., Eckhoff, J. and Meining, A. (2022). How effective is laparoscopic redo-antireflux surgery? Dis. Esophagus, 35 (3). CARY: OXFORD UNIV PRESS INC. ISSN 1442-2050
Full text not available from this repository.Abstract
Background: The failure-rate after primary antireflux surgery ranges from 3 to 30%. Reasons for failures are multifactorial. The aim of this study is to gain insight into the complex reasons for, and management of, failure after antireflux surgery. Methods: Patients were selected for redo-surgery after a diagnostic workup consisting of history and physical examination, upper gastrointestinal endoscopy, quality-of-life assessment, screening for somatoform disorders, esophageal manometry, 24-hour-pH-impedance monitoring, and selective radiographic studies such as Barium-sandwich for esophageal passage and delayed gastric emptying. Perioperative and follow-up data were compiled between 2004 and 2017. Results: In total, 578 datasets were analyzed. The patient cohort undergoing a first redo-procedure (n = 401) consisted of 36 patients after in-house primary LF and 365 external referrals (mean age: 62.1 years [25-87]; mean BMI 26 [20-34]). The majority of patients underwent a repeated total or partial laparoscopic fundoplication. Major reasons for failure were migration and insufficient mobilization during the primary operation. With each increasing number of required redo-operations, the complexity of the redo-procedure itself increased, follow-up quality-of-life decreased (GIQLI: 106; 101; and 100), and complication rate increased (intraoperative: 6,4-10%; postoperative: 4,5-19%/first to third redo). After three redo-operations, resections were frequently necessary (morbidity: 42%). Conclusions: Providing a careful patient selection, primary redo-antireflux procedures have proven to be highly successful. It is often the final chance for a satisfying result may be achieved upon performing a second redo-procedure. A third revision may solve critical problems, such as severe pain and/or inadequate nutritional intake. When resection is required, quality of life cannot be entirely normalized.
Item Type: | Journal Article | ||||||||||||||||||||||||||||
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URN: | urn:nbn:de:hbz:38-581313 | ||||||||||||||||||||||||||||
DOI: | 10.1093/dote/doab091 | ||||||||||||||||||||||||||||
Journal or Publication Title: | Dis. Esophagus | ||||||||||||||||||||||||||||
Volume: | 35 | ||||||||||||||||||||||||||||
Number: | 3 | ||||||||||||||||||||||||||||
Date: | 2022 | ||||||||||||||||||||||||||||
Publisher: | OXFORD UNIV PRESS INC | ||||||||||||||||||||||||||||
Place of Publication: | CARY | ||||||||||||||||||||||||||||
ISSN: | 1442-2050 | ||||||||||||||||||||||||||||
Language: | English | ||||||||||||||||||||||||||||
Faculty: | Unspecified | ||||||||||||||||||||||||||||
Divisions: | Unspecified | ||||||||||||||||||||||||||||
Subjects: | no entry | ||||||||||||||||||||||||||||
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URI: | http://kups.ub.uni-koeln.de/id/eprint/58131 |
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