Long-Term Subjective Outcomes of Reintervention for Failed Fundoplication: Redo Fundoplication Versus Roux-En-Y Reconstruction

Se Ryung Yamamoto, MD

Department of Surgery, Creighton University Medical Center, Omaha, NE, USA

Background: Redo fundoplication (Redo) is the mainstay of treatment for failed previous fundoplication, but is not always feasible. A subset of patients require Roux-en-Y reconstruction (RNY) for symptom relief. The aim of the study was to assess the long term subjective outcomes between Redo and RNY in patients with failed fundoplication.

Methods: In this retrospective review of prospectively maintained database, we identified 119 consecutive patients with Redo fundoplication (mean 54.1 years, 78 women) and 64 patients with RNY (mean 54.8 years, 35 women) between December 2003 and September 2009. Data variables analyzed were, patients’ characteristics, esophageal manometry, 24h pH study, type of procedure, peri-operative findings, complications, pre and post symptom (heartburn, regurgitation, dysphagia and chest pain) scores (scale 0-3), and patients’ satisfaction score (scale 1-10). Patients with grade 2 and 3 were considered to have severe symptoms. In addition, the use of proton pump inhibitors (PPI) and histamine 2 (H2) receptor antagonists were analyzed.

Results: There were significant differences noted in BMI (29.6 vs 31.5 kg/m2, p=0.023), pre op BMI > 35 kg/m2 (16/119 13 vs 17/64 27%, p=0.028), operative time (190 vs 240 min, p<0.001), estimated blood loss (100 vs 200 ml, p=0.001), length of hospital stay (3 vs 6 days, p<0.001) between Redo and RNY groups respectively. Of the 183 patients, long term (>3 years) follow up is available in 108 (78 redo and 30 RNY) patients. Both procedure showed significant improvement in symptom scores after the procedure. There was no significant difference in patient’s satisfaction between Redo and RNY groups. In the subset analysis, patients with BMI>35 kg/m2 have better satisfaction with RNY compared to Redo (p=0.044).

Conclusions: Redo fundoplication in patients with previously failed intervention is associated with satisfactory long term outcomes. However, Roux-en-Y reconstruction is a useful surgical option for patients with failed previous antireflux surgery and especially, patients with BMI> 35 kg/m2 should be considered for Roux en Y reconstruction.

Session: Podium Presentation

Program Number: S093

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