Minimally invasive redo antireflux surgery: lessons learned.

Abstract

Reoperative antireflux procedures are traditionally approached through an open technique. However, with increasing experience in minimally invasive antireflux procedures, more reoperative procedures are being performed laparoscopically. The success rate for reoperative surgery, either open or laparoscopic, does not equal that of primary antireflux operations. Redo antireflux surgery is a complex operation and a thorough evaluation prior to treatment is essential. There are several options for failed primary antireflux surgery including reconstructive options, such as redo fundoplication and Roux-en Y near esophagojejunostomy. In some cases of anatomic disruption, esophagectomy is required. In this article, we discuss the following: clinical presentation; the evaluation of patients; causes of failure; and choice of operation with a focus on reconstructive options, and technical aspects of minimally invasive redo antireflux surgery. We describe our experience and summarize the lessons learned.