The international surgical journal with global reach

This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS

Long‐term outcomes of revisional surgery following laparoscopic fundoplication. BJS 2009; 96: 391-397.

Published: 12th March 2009

Authors: P. J. Lamb, J. C. Myers, G. G. Jamieson, S. K. Thompson, P. G. Devitt, D. I. Watson et al.

Background

A small proportion of patients who have laparoscopic antireflux procedures require revisional surgery. This study investigated long‐term clinical outcomes.

Method

Patients requiring late revisional surgery following laparoscopic fundoplication for gastro‐oesophageal reflux were identified from a prospective database. Long‐term outcomes were determined using a questionnaire evaluating symptom scores for heartburn, dysphagia and satisfaction.

Results

The database search found 109 patients, including 98 (5·6 per cent) of 1751 patients who had primary surgery in the authors' unit. Indications for surgical revision were dysphagia (52 patients), recurrent reflux (36), mechanical symptoms related to paraoesophageal herniation (16) and atypical symptoms (five). The median time to revision was 26 months. Outcome data were available for 104 patients (median follow‐up 66 months) and satisfaction data for 102, 88 of whom were highly satisfied (62·7 per cent) or satisfied (23·5 per cent) with the outcome. Patients who had revision for dysphagia had a higher incidence of poorly controlled heartburn (20 versus 2 per cent; P = 0·004), troublesome dysphagia (16 versus 6 per cent; P = 0·118) and a lower satisfaction score (P = 0·023) than those with recurrent reflux or paraoesophageal herniation.

Conclusion

Revisional surgery following laparoscopic fundoplication can produce good long‐term results, but revision for dysphagia has less satisfactory outcomes. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

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