Article

Failed fundoplications

Department of Surgery, University of Utah, 30N 1900E, Salt Lake City, UT 84132, USA.
The American Journal of Surgery (Impact Factor: 2.41). 01/2005; 188(6):786-91. DOI: 10.1016/j.amjsurg.2004.08.062
Source: PubMed

ABSTRACT Five percent of patients who undergo fundoplication will require reoperation. The cause of this high failure rate and the best management for these patients remains poorly understood. The aim of this study was to identify patterns and causes of failure of primary antireflux procedures.
Retrospective review of the medical records of patients who underwent revisional antireflux surgery at 2 tertiary referral centers.
Between 1998 and 2003, 39 patients underwent laparoscopic revisional antireflux surgery. The time between primary and revisional surgery was 5.9 +/- 0.4 years. Primary operations included 26 laparoscopic and 13 open fundoplications. All of the 39 revisional operations were attempted laparoscopically, and there was 1 open conversion. Revisional procedures included 31 Nissen and 8 partial fundoplications. The duration of surgery was 138 +/- 10 minutes. Length of hospital stay was 2.1 +/- 0.3 days. At a mean follow-up of 6 months, reflux resolved in 94% of patients. Morbidity occurred in 23% of patients. Four types of failure were identified: type 1 = herniation of the gastroesophageal junction through the hiatus with or without the wrap (n = 21); type 2 = paraesophageal hernia (n = 9); type 3 = malformation of the wrap (n = 2). Six patients had primary wrap failure, and 1 had esophageal dysmotility.
Laparoscopic revisional antireflux surgery is effective treatment for patients with failed primary fundoplications. Successful revisional surgery depends on identification and correction of the reason for primary fundoplication failure.

0 Followers
 · 
76 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with postoperative gastroesophageal reflux (GER). We performed a systematic review of the literature regarding routine anti-reflux medication post EA-TEF repair and its impact on postoperative GER and associated complications. A comprehensive search was conducted using MEDLINE, EMBASE, CINHAL, CENTRAL (Cochrane library) electronic databases and gray literature. Full-text screening was performed in duplicate. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with anti-reflux medications. Screening of 2,910 articles resulted in 25 articles (1,663 patients) for analysis. Most were single-center studies (92 %) and retrospective (76 %); there were no randomized control trials. Fifteen studies named the class of anti-reflux agent used, 3 the duration of therapy, and none either the dose prescribed or number of doses. Complications were inconsistently reported. Anti-reflux surgery was performed in 433/1,663 (26.0 %) patients. Average follow-up was 53.2 months (14 studies). The quality of literature regarding anti-reflux medication for GER post EA-TEF repair is poor. There are no well-outlined algorithms for anti-reflux agents, doses, or duration of therapy. Standardized protocols and reliable reporting are necessary to develop guidelines to better manage postoperative GER in EA-TEF patients.
    Pediatric Surgery International 07/2014; 30(10). DOI:10.1007/s00383-014-3548-0 · 1.06 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Erratum to: Surg Endosc DOI 10.1007/s00464-014-3660-1There is a shared first authorship between the first two authors, T. Zhou and C. Harnsberger, as both contributed equally to this paper.The affiliation for T. Zhou should be:Department of General Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, San Diego, CA, USAThe affiliation for C. Harnsberger, R. Broderick, H. Fuchs, G. Jacobsen, S. Horgan, D. Chang, B. Sandler should be:Department of General Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, San Diego, CA, USAThe affiliation for M. Talamini should be:Department of Surgery, Health Sciences Center T19-020, Stony Brook Medicine, Stony Brook, NY 11794-8191, USA
    Surgical Endoscopy 07/2014; 29(3). DOI:10.1007/s00464-014-3660-1 · 3.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is commonly associated with gastroesophageal reflux (GER) after surgical repair. One risk factor for anastomotic stricture is post-operative GER. This survey assessed practice patterns among attendees at the Canadian Association of Pediatric Surgeons (CAPS) annual meeting with respect to management of GER post EA-TEF repair. Methods A pre-piloted survey was handed out and collected at the 2012 CAPS annual meeting. Data was entered and coded, and descriptive statistics were calculated. Results We distributed 70 surveys, and 57 (81.4%) surveys were returned. On average, the incidence of EA-TEF is 8–10 cases per institution, per year. Anti-reflux medication is started immediately post-operatively in 74% of patients at institution of feeds (11%), or if symptoms of reflux develop (14%). Proton pump inhibitors and H2-receptor antagonists are used in approximately equal proportion. Patients are typically kept on anti-reflux medication for 3–6 months (37%) or 6–12 months (35%). Conclusions Most CAPS attendees treat postoperative GER prophylactically. However, there is no consistency in management strategy regarding which anti-reflux agent to use or for how long. A multi-centered study is required to establish a standardized protocol for the post-operative management of EA-TEF to prevent reflux and its effect on anastomotic strictures.
    Journal of Pediatric Surgery 05/2014; DOI:10.1016/j.jpedsurg.2014.02.052 · 1.31 Impact Factor