Comparison of Surgical Procedures Performed in Patients Undergoing First Redo vs Repeat Redo Anti-reflux Surgery

Harit Kapoor, MBBS, Pradeep Pallati, MD, Shunsuke Akimoto, MD, Kalyana Nandipatti, MD, Tommy H Lee, MD, Sumeet K Mittal, MD. Creighton University

Background: A subset of patients with anti-reflux surgery require re-operative intervention. Re-operative intervention is associated with higher intra-operative complications when compared to primary fundoplication. Some patients may have recurrent failure and may require re-intervention which may have an even higher risk of complications. The aim of this study was to compare the operative anti-reflux procedures performed in patients who underwent first redo-anti-reflux surgery (Group A) with those who underwent re-operative anti-reflux surgery after at least one previous failed redo procedure (Group B) at our institution.

Methods: All patients undergoing anti-reflux procedures are entered in a prospectively maintained database. After Institutional Review Board approval, database was reviewed to identify patients who underwent redo-anti-reflux surgery between July 2003 and July 2014. These patients were divided into two groups, one group who underwent their first redo procedure (Group A) and another group with patients who underwent their 2nd (or greater) redo anti-reflux procedure (Group B). Data variables analyzed include demographics, surgical procedures performed, use of mesh for hiatal approximation and use of additional esophageal lengthening procedure. Chi square test and t-tests were used to compare the various variables among the groups.

Results: A total of 285 (254 with first redo, 24 with second redo, 5 with third redo and 1 each with fourth and fifth redo) underwent re-operative intervention during the study period. Group A had 254 patients (Redo-fundoplication, 69%; Redo-Roux-n-Y, 31%) and Group B had 31 patients (Redo-fundoplication, 64.5%; Redo-Roux-n-Y, 35.5%). Both groups had similar mean ages, BMI and sex distribution. Percentage of patients who underwent Roux-n-Y gastro-jejunostomy were similar in both groups. In those patients who underwent redo-fundoplication, Toupet (44.6% vs 50%) and Nissen (37.7% vs 20%) were the most commonly performed in both the groups. Although not reaching statistical significance, laparoscopic approach was utilized much more in group A compared to group B (72% vs 38.7%). No difference was found with regards to use Collis gastroplasty (11.8% vs 9.7%).

Conclusion: Laparoscopic approach can be acceptably undertaken while performing first redo-anti-reflux procedure but second or greater re-operative revisions are more likely to need open approaches.

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