Analysis of outcomes of reoperative fundoplication in more than 500 patients after failed primary antireflux surgery: Experience over two decades.

Abstract

With an increase in the volume of antireflux procedures performed annually, an increasing number of patients with recurrent symptoms after a primary antireflux operation are being referred to thoracic surgeons for complex redo operations. The primary objectives of this study were to evaluate the outcomes of redo fundoplication after failed antireflux operations and to identify risk factors associated with failure of the redo fundoplication. We conducted a retrospective review of patients who underwent redo fundoplication. The primary end point evaluated was failure of the redo operation. We also evaluated factors associated with failure of redo fundoplication and postoperative quality of life metrics. A total of 526 patients underwent redo fundoplication (511 minimally invasive; 97%) after 1 or more prior antireflux operations. Nissen fundoplication was performed in 400 patients (76%), Collis gastroplasty in 165 patients (31%), and partial fundoplication in 126 patients (24%). At a median follow-up of 113 months, 88 patients (17%) had a failure of the redo surgery requiring reoperation. The probability of 5-year failure-free survival was 85% (95% CI, 81-88). In univariate analysis, factors that were significantly associated with failure of the redo fundoplication included age (P = .002), number of redo procedures (P < .001), and type of redo fundoplication (P = .003). Thoracic surgeons with significant laparoscopic and open esophageal surgical experience can perform minimally invasive, complex redo antireflux procedures safely with good results. Type of fundoplication, age, and number of prior operations are associated with failure of the redo fundoplication. Further work is required to analyze confounding variables to optimize patient selection.