The Success Rate of Fundoplication Decreases after Each Redo Antireflux Operation

Cristina R Harnsberger, MD¹, Ryan C Broderick, MD¹, Hans F Fuchs, MD¹, Tianzan Zhou, BA¹, Garth R Jacobsen, MD¹, David C Chang, PhD, MBA, MPH², Karl-Hermann Fuchs, MD³, Santiago Horgan, MD¹, Bryan J Sandler, MD¹. ¹University of California, San Diego, Department of Surgery, ²Massachusetts General Hospital, Harvard Medical School, ³Markus Krankenhaus, Frankfurt, Germany

BACKGROUND:

Following laparoscopic fundoplication a small percentage of patients will develop recurrent symptoms, however only approximately 65% of these patients will undergo revisional surgery. The success of redo antireflux surgery compared with initial fundoplication is disputed in literature, and those who fail once may require multiple revisional operations. We aim to describe the frequency of multiple redo fundoplications due to failed antireflux surgery using a large population database.

METHODS:

A longitudinal version of the California Office of Statewide Health Planning and Development (OSHPD) database was used, which includes all patients from every civilian hospital in California. Using ICD-9 codes, patients were included if they underwent laparoscopic fundoplication for GERD or hiatal hernia. Patients were excluded if they had complications of GERD, esophageal or gastric cancer, prior esophageal or gastric surgery, esophageal dysmotility, or diaphragmatic hernia with gangrene or obstruction. Censoring events included esophageal or gastric cancer and any other esophageal or gastric surgery. The rates of redo fundoplications were analyzed.

RESULTS:

From 1995-2010, 13,050 patients were included in the study. Overall, 465 (3.5%) patients underwent at least one revision fundoplication. Out of the patients who had an initial redo antireflux operation, 19 (4.1%) went on to receive to a second revision, of which 2 (10.5%) underwent a third (Figure 1). During the 11-year study interval, no patient had more than three redo fundoplications.

CONCLUSION:

Increasing rates of second and third revision fundoplication suggest that the success of repeated revision antireflux surgery diminishes with each subsequent intervention.