Patient centered outcomes over time after redo-RNY for failed fundoplication

Shunsuke Akimoto, Saurabh Singhal, Sumeet K Mittal. Creighton University Medical Center

Introduction: As Antireflux surgeries have become common, more patients are presenting with need for reoperative interventions. We assessed our patient for short, mid and long term subjective outcome following redo Roux-en-Y reconstruction (RNY) for failed fundoplications.

Methods: After IRB approval, we identified patients who had undergone redo RNY between December 2003 and June 2010. Database contains patient follow-ups. Patients with short term follow-up (1-2 years) form group A, those with mid-term follow-up 2-5 years (Group B) and those with long term follow-up (>5 years) for group C. Patient reported symptoms [0(low)-3(high)], satisfaction [1(low)-10(high)] and use of medications was compared between the groups. We decided symptom score 2 and 3 as severe symptom. We decided satisfaction score 8-10 as excellent satisfaction.

Results: A total of 203 patients underwent redo-anti-reflux surgery during the study period, of which 70 patient who had undergone RNY formed the cohort for this study. Follow-up at short term, mid term and long term was available for 25 patients, 41 patients and 21 patients respectively. Severe symptoms were not significantly different among all groups (heartburn: 16% vs. 19.5% vs. 28.6%, dysphagia: 20% vs. 14.6% vs. 19%, regurgitation: 8% vs. 4.9% vs. 4.8%, chest pain: 4% vs. 2.4% vs. 9.5%, respectively, all values p >0.05). Proportion of patients reporting excellent satisfaction increased overtime but it was not statistically significance (64% vs. 82.9% vs. 76.2% p >0.05).

Conclusion: Redo RNY patients following failed fundoplications show excellent satisfaction in long term with no worsening of symptoms.

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