Best reoperative strategy for failed fundoplication: redo fundoplication or conversion to Roux-en-Y gastric diversion?

2020 ◽  
Author(s):  
Jenny M. Shao ◽  
Sharbel A. Elhage ◽  
Tanu Prasad ◽  
Keith Gersin ◽  
Vedra A. Augenstein ◽  
...  
Keyword(s):  
Failed Fundoplication ◽  
Redo Fundoplication

23 GASTRIC BYPASS AS REVISION SURGERY FOR FAILED FUNDOPLICATIONS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Reda Ezz
Keyword(s):  
Revision Surgery ◽  
Laparoscopic Fundoplication ◽  
Revisional Surgery ◽  
Cost Effective ◽  
Recurrent Reflux ◽  
Failed Fundoplication ◽  
Redo Fundoplication ◽  
Bile Gastritis ◽  
Cost Effective Alternative

Abstract   Laparoscopic fundoplication as anti-reflux technique has emerged and widely expanded as a cost effective alternative to life-long medical treatment in patients with gastroesophageal reflux disease (GERD). Long-term success rate ranges from 80–90% with this procedure, but side effects still exist even with experienced surgeons. Patients with a failed anti-reflux procedure are becoming a more common problem nowadays. Although most of these patients can be managed medically, still some of them will require revisional surgery. Methods We presented our experience from January 2015 to June 2019 facing cases of failed fundoplications. 59 cases with failed fundoplication requiring revision were included in the study. Redo fundoplications were decided preoperatively or intraoperatively to be difficult or unsafe to be done for these cases. Revision surgery for these cases was done using either distal gastrectomy and RY gastro-jejunostomy (22 cases) when the hiatal dissection was not feasible or unsafe due to obscure anatomy or Truncal vagotomy and RY gastro-jejunostomy (37 cases) when the hiatal dissection was easy and feasible. Results Laparoscopy was used in 49 cases and was successfully completed in 42cases (%) and 7conversion (%). Improvement of symptoms: Recurrent reflux or dysphagia was noted in 19 cases (32%) and complete disappeared in 26 cases (44%). One case had leak from the GJ and another one got hematemesis. Both cases were managed conservatively. Nine patient (15%) had bile gastritis with abdominal pain. Five patients (8.5%) complained of dumping symptoms. No mortality was recorded. Conclusion RY gastro-jejunostomy for failed fundoplications is a valid, feasible surgical option when redo fundoplication is difficult to be done or if associated with possible or expected complications.

Long-term outcomes of reintervention for failed fundoplication: redo fundoplication versus Roux-en-Y reconstruction

2013 ◽  
Vol 28 (1) ◽  
pp. 42-48 ◽  
Author(s):  
Se Ryung Yamamoto ◽  
Masato Hoshino ◽  
Kalyana C. Nandipati ◽  
Tommy H. Lee ◽  
Sumeet K. Mittal
Keyword(s):  
Long Term Outcomes ◽  
Failed Fundoplication ◽  
Redo Fundoplication

scholarly journals FAILURE AFTER FUNDOPLICATION: RE-FUNDOPLICATION? IS THERE A ROOM FOR GASTRECTOMY? IN WHICH CLINICAL SCENARIES?

2019 ◽  
Vol 32 (2) ◽  
Author(s):  
Italo BRAGHETTO ◽  
Attila CSENDES
Keyword(s):  
Distal Gastrectomy ◽  
Ph Monitoring ◽  
Postoperative Outcome ◽  
Clinical Situation ◽  
Clinical Results ◽  
Obese Patients ◽  
Failed Fundoplication ◽  
Redo Fundoplication ◽  
Important Addition ◽  
Endoscopic Esophagitis

ABSTRACT Background: Re-fundoplication is the most often procedure performed after failed fundoplication, but re-failure is even higher. Aim: The objectives are: a) to discuss the results of fundoplication and re-fundoplication in these cases, and b) to analyze in which clinical situation there is a room for gastrectomy after failed fundoplication. Method: This experience includes 104 patients submitted to re-fundoplication after failure of the initial operation, 50 cases of long segment Barrett´s esophagus and 60 patients with morbid obesity, comparing the postoperative outcome in terms of clinical, endoscopic, manometric and 24h pH monitoring results. Results: In patients with failure after initial fundoplication, redo-fundoplication shows the worst clinical results (symptoms, endoscopic esophagitis, manometry and 24 h pH monitoring). In patients with long segment Barrett´s esophagus, better results were observed after fundoplication plus Roux-en-Y distal gastrectomy and in obese patients similar results regarding symptoms, endoscopic esophagitis and 24h pH monitoring were observed after both fundoplication plus distal gastrectomy or laparoscopic resectional gastric bypass, while regarding manometry, normal LES pressure was observed only after fundoplication plus distal gastrectomy. Conclusion: Distal gastrectomy is recommended for patients with failure after initial fundoplication, patients with long segment Barrett´s esophagus and obese patients with gastroesophageal reflux disease and Barrett´s esophagus. Despite its higher morbidity, this procedure represents an important addition to the surgical armamentarium.

scholarly journals Long-Term Health-Related Quality of Life (HRQoL) After Redo-Fundoplication

2021 ◽  
Author(s):  
Antti J. Kivelä ◽  
Juha Kauppi ◽  
Jari Räsänen ◽  
Anna But ◽  
Harri Sintonen ◽  
...  
Keyword(s):  
Multivariable Analysis ◽  
University Hospital ◽  
Safe Procedure ◽  
Linear Regression Models ◽  
Hrqol Score ◽  
Failed Fundoplication ◽  
Redo Fundoplication ◽  
Disease Specific

Abstract Background We aim to shed light on long-term subjective outcomes after re-operations for failed fundoplication. Methods 1809 patients were operated on for hiatal hernia and/or gastroesophageal reflux disease (GERD) at the Helsinki University Hospital between 2000 and 2017. 111 (6%) of these had undergone a re-operation for a failed antireflux operation. Overall, HRQoL was assessed in 89 patients at the latest follow-up using the generic 15D© instrument. The results were compared to a sample of the general population, weighted to reflect the age and gender distribution of patients. Disease-specific HRQoL was assessed using the GERD-HRQoL questionnaire. We studied variation in the overall HRQoL with respect to disease-specific HRQoL and known patients' parameters using univariate and multivariable linear regression models. Results The median postoperative follow-up period was 9.3 years. All patients were operated on laparoscopically (6% conversion rate), and 87% were satisfied with the re-operation. Postoperative complications were minimal (5%). Twelve patients (11%) underwent a second re-operation. The median GERD-HRQoL score was nine. In multivariable analysis, four variables were independently associated with the 15D score, suggesting a decrease in the 15D score with increasing GERD-HRQoL score, increasing Charlson Comorbidity Index (CCI) and the presence of chronic pain syndrome (CPS) and depression. Conclusion Re-do LF is a safe procedure in experienced hands and may offer acceptable long-term alleviation in patients with recurring symptoms after antireflux surgery. Decreased HRQoL in the long run is related to recurring GERD and co-morbidities.

scholarly journals Short and long-term outcomes after pediatric redo fundoplication

2021 ◽  
Author(s):  
Morten Kvello ◽  
Charlotte K. Knatten ◽  
Thomas J. Fyhn ◽  
Kristin Bjørnland
Keyword(s):  
Long Term Outcomes ◽  
Redo Fundoplication ◽  
Short And Long Term

Medium- and long-term outcome of laparoscopic redo fundoplication

2006 ◽  
Vol 20 (12) ◽  
pp. 1817-1823 ◽  
Author(s):  
B. K. Oelschlager ◽  
D. R. Lal ◽  
E. Jensen ◽  
M. Cahill ◽  
E. Quiroga ◽  
...  
Keyword(s):  
Term Outcome ◽  
Long Term Outcome ◽  
Redo Fundoplication

PS01.018: PERSISTENT DYSPHAGIA AFTER FUNDOPLICATION WITH MESH PLASTY –MISSED OR MISTAKEN –A CASE REPORT

2018 ◽  
Vol 31 (Supplement_1) ◽  
pp. 55-55
Author(s):  
Servarayan Chandramohan ◽  
Visvarath Varadharajan ◽  
Madeshwaran Chinnathambi ◽  
Kanagavel Manickavasagam ◽  
Abishai Jebaraj ◽  
...  
Keyword(s):  
Skin Biopsy ◽  
Mesh Repair ◽  
Conflicts Of Interest ◽  
Case Reports ◽  
Systemic Disease ◽  
Transhiatal Esophagectomy ◽  
High Resolution Manometry ◽  
Failed Fundoplication ◽  
Rule Out

Abstract Background Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement. Methods 58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone. Results The patient is free of dysphagia and is on regular follow up. Conclusion In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure. Disclosure All authors have declared no conflicts of interest.

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