Long-term Symptomatic Outcomes in Patients Undergoing Re-operative Fundoplication

Masato Hoshino, Ananth Srinivasan, Amith V Reddy, Tommy H Lee, Sumeet K Mittal. Creighton University Medical Center


INTRODUCTION: Re-do fundoplication is a viable and safe option in the management of the symptomatic post-fundoplication patients. The purpose of this study was to evaluate subjective outcomes and satisfaction of redo-fundoplication more than 3 years after surgery.
METHODS AND PROCEDURES: After IRB approval, a prospectively maintained database was retrospectively reviewed to identify patients who underwent a redo-fundoplication with 3 years or greater follow. Data was analyzed for manometry, 24h pH study, surgical approach and procedure, peri-operative findings, complications and pre and post symptom (heartburn, regurgitation, dysphagia and chest pain) scores (scale 0-3), along with patients’ satisfaction score (scale 1-10). Patients with grade 2 and 3 were considered to have severe symptoms. All data was expressed as median (IQR). Chi-square test was used to compare categorical variables. Mann-Whitney’s U test and Wilcoxon test were used to compare continuous variables. A p-value < 0.05 was considered statistically significant.
RESULTS: We identified 104 consecutive patients [70 (67%) females, 57.5 (45.5-66) years]. The majority of surgical approach was laparoscopic (66%) (Conversion rate was 7%). 16% patients with short esophagus underwent collis-fundoplication. Overall complication rate was 21% with no –peri-operative mortality. The median follow up of 50 (range: 37-91) months was available in 73 (70%) patients. There was significant decline in number of patients reporting significant regurgitation (p = 0.035), dysphagia (p < 0.001), chest pain (p < 0.001). 27% postoperative reported taking PPI or/and H2 blocker compared to preoperative 46% patients (p = 0.012) and the 70% reported excellent to high satisfaction with outcome (8 or higher on a scale 1-10).
CONCLUSION: Patients undergoing redo-fundoplication can expect durable improvement of symptoms and high satisfaction more than four years after surgery.

Session Number: Poster – Poster Presentations
Program Number: P231
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