REOPERATIONS AFTER FAILED ANTIREFLUX PROCEDURES

With the advent of laparoscopic surgery, the number of anti-reflux procedures performed has virtually exploded in some centers. Persistent, recurrent or new symptoms after an antireflux procedure are therefore likely to become a more common problem in the near future. Recurrent reflux is usually due to a breakdown of the repair and can frequently be treated medically or by a repeat antireflux procedure. In contrast, postoperative dysphagia, with or without accompanying reflux symptoms, may be due to a myriad of causes which include a slipped wrap, a wrap that has been placed around the stomach rather than the esophagus, a wrap which is either too tight or too long, the development of a stricture, the presence of a motor disorder of the esophageal body, or a combination of these factors. These situations can not usually be solved by a simple redo fundoplication or medications. Rather, the successful management of these patients requires an individual therapeutic approach, based on the presenting symptom or symptom constellation, the results of function tests and the intraoperative findings. The surgeon caring for patients with failed antireflux procedures should be intimately acquainted with the whole spectrum of revisional, resective and reconstructive procedures of the stomach, cardia, and esophagus.