Kento Mishima, MD1, Hitoshi Idani1, Tetsushi Kubota, MD1, Shinya Asami, MD2, Kanyu Nakano, MD1, Masao Harano, MD1, Norihisa Takakura, MD2. 1Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, 2Department of Surgery, Fukuyama City Hospital
It has been reported that Laparoscopic redo surgery is effective for recurrent GERD and/or hiatal hernia after surgery. However, there has been very few reports from Japan. We report an initial experience of laparoscopic surgery for Japanese patients with recurrent GERD and/or hiatal hernia. Among 177 patients who had undergone laparoscopic fundoplication in our hospital from 1997 to 2016, 15 patients with recurrent GERD/hiatal hernia underwent redo surgery. Preoperative work-up included upper GI series, endoscopy, CT, 24 h pH-impedance and manometry. The patients consisted of 8 women and 7 men with a mean age of 65.8 years. The interval from the initial surgery was 26.7 months (4days-60 months). The types of initial fundoplication were Nissen:10, Toupet:4, Anterior:1. The types of recurrence were sliding hernia:11 and paraesophageal hernia:4. One patient with recurrent sliding hernia had poor gastric motility. Laparoscopic redo surgery was performed on 14 patients. Redo surgery included crural repair with mesh reinforcement:3, refundoplication:10 (Nissen-Nissen:3,Nissen-Toupet:5,Toupet-Toupet:1,Toupet-lateral:1) and reduction of the incarcerated paraesophageal hernia:1. Additional procedure included mesh reinforcement:4 and pyloroplasty:1. Open partial gastrectomy was performed for one patient with incarcerated and strangulated hernia. Operation time was 226min. 3 patients was converted to open surgery. Oral intake was started on the 1st POD and postoperative stay was 6.5 days. Two patients recurred after redo surgery, one of whom underwent re-redo surgery. During the surgery, IVC was injured but rescued by open surgery. Eleven patients had good outcome and 4 patients required PPI after redo surgery. Our morphological fundoplication score significantly improved after redo surgery. Symptom score and acid exposure time were also significantly improved after redo surgery. Laparoscopic redo surgery for recurrent GERD and/or hiatal hernia after surgery is safe and effective, although attention should be paid during surgery to avoid injury of the adjacent organs.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86396
Program Number: P443
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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