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
Predictors of symptomatic and objective outcomes after surgical reintervention for failed antireflux surgery. BJS 2008; 95: 1369-1374.
Published: 9th October 2008
Authors: E. J. B. Furnée, W. A. Draaisma, I. A. M. J. Broeders, A. J. P. M. Smout, A. L. M. Vlek, H. G. Gooszen et al.
Background
Recurrent gastro‐oesophageal reflux disease (GORD) and troublesome dysphagia after primary antireflux surgery are treated successfully by reoperation in 70 per cent of patients. Identifying predictors of outcome could allow selection of patients likely to benefit from further surgery. The aim was to identify such predictors in patients reoperated on for recurrent GORD or troublesome dysphagia.
Method
Between 1994 and 2005, 83 patients (mean(s.d.) age 47·2(14·4) years; 47 men) with recurrent GORD and 47 (aged 50·7(13·4) years; 18 men) with troublesome dysphagia had further surgery. The predictive values of demographic, anatomical and manometric variables, and 24‐h pH monitoring were analysed with respect to symptomatic and objective outcomes in each group.
Results
None of the factors included in a multivariable analysis predicted outcome after surgery for recurrent GORD. Independent predictors of symptomatic outcome after reoperation for dysphagia were amplitude of distal oesophageal contractions (odds ratio (OR) 1·613 (95 per cent confidence interval (c.i.) 1·087 to 2·393); P = 0·017), intrathoracic wrap migration (OR 0·077 (0·003 to 1·755); P = 0·108) and an abdominal approach (OR 0·012 (0·001 to 0·337); P = 0·009).
Conclusion
Low‐amplitude distal oesophageal contractions, intrathoracic wrap migration and an abdominal approach were significant predictors of an unsuccessful symptomatic outcome after reoperation for troublesome dysphagia. Copyright © 2008 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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