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Surgical Endoscopy
Published in: Surgical Endoscopy 1/2018

01-01-2018

Patterns of reoperation after failed fundoplication: an analysis of 9462 patients

Authors: Nabeel R. Obeid, Maria S. Altieri, Jie Yang, Jihye Park, Kristie Price, Andrew Bates, Aurora D. Pryor

Published in: Surgical Endoscopy | Issue 1/2018

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Abstract

Background

Little is known about the choice of reoperation after failed fundoplication for gastroesophageal reflux disease. Both redo fundoplication and conversion procedure to Roux-en-Y gastric bypass (RYGB) are safe and effective. We aimed to characterize the rates of different revisional procedures and to identify risk factors associated with failed fundoplication.

Methods

Using a statewide database, we examined records for patients who underwent fundoplication between 2000 and 2010. The primary outcomes were the rate of each type of reoperation and the pattern of subsequent procedures. Demographics and comorbidities were used in a multivariable logistic regression model to identify risk factors associated with reoperation after fundoplication.

Results

A total of 9462 patients were included. Overall, 430 (4.5%) patients underwent reoperation. Of those, 46 (10.7%) patients underwent RYGB at first reoperation, with the remainder having a redo fundoplication. An additional five patients were converted to RYGB after undergoing a redo fundoplication (51 total patients converted to RYGB at any point, 11.9%). Eighty-three percent of patients converted to RYGB were obese, as opposed to 8% for redo fundoplication. A single redo fundoplication was done in 81% of patients, while 35 patients (8.1%) underwent two or more revisional procedures. On average, any reoperation was performed 2.9 years after fundoplication, with redo fundoplication 2.5 years and RYGB 6.5 years later. Age 30–49 years (vs. >70 years; OR 2.01, p = 0.011) and 50–69 years (vs. >70 years; OR 1.61, p = 0.011), female gender (OR 1.56, p = < 0.0001), and chronic pulmonary disease (OR 1.40, p = 0.0044) were associated with revisional surgery.

Conclusions

Fundoplication has a low reoperation rate within a mean 8.3 years of follow-up. Redo fundoplication is more commonly performed and at an earlier point than conversion to RYGB. Younger age, female gender, and chronic pulmonary disease are associated with reoperation after fundoplication.
Literature
1.
El-Serag HB, Sweet S, Winchester CC, Dent J (2014) Update on the epidemiology of gastro-esophageal reflux disease: a systematic review. Gut 63:871–880CrossRefPubMed
2.
Broeders JA, Rijnhart-de Jong HG, Draaisma WA, Bredenoord AJ, Smout AJ, Gooszen HG (2009) Ten-year outcome of laparoscopic and conventional Nissen fundoplication: randomized clinical trial. Ann Surg 250:698–706CrossRefPubMed
3.
Morgenthal CB, Shane MD, Stival A, Gletsu N, Milam G, Swafford V, Hunter JG, Smith CD (2007) The durability of laparoscopic Nissen fundoplication: 11-year outcomes. J Gastrointest Surg 11:693–700CrossRefPubMed
4.
Suter M, Dorta G, Giusti V, Calmes JM (2004) Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients. Obes Surg 14:959–966CrossRefPubMed
5.
Smith SC, Edwards CB, Goodman GN (1997) Symptomatic and clinical improvement in morbidly obese patients with gastroesophageal reflux disease following Roux-en-Y gastric bypass. Obes Surg 7:479–484CrossRefPubMed
6.
Ortega J, Escudero MD, Mora F, Sala C, Flor B, Martinez-Valls J, Sanchiz V, Martinez-Alzamora N, Benages A, Lledo S (2004) Outcome of esophageal function and 24-hour esophageal pH monitoring after vertical banded gastroplasty and Roux-en-Y gastric bypass. Obes Surg 14:1086–1094CrossRefPubMed
7.
Merrouche M, Sabate JM, Jouet P, Harnois F, Scaringi S, Coffin B, Msika S (2007) Gastro-esophageal reflux and esophageal motility disorders in morbidly obese patients before and after bariatric surgery. Obes Surg 17:894–900CrossRefPubMed
8.
9.
Khajanchee YS, O’Rourke R, Cassera MA, Gatta P, Hansen PD, Swanstrom LL (2007) Laparoscopic reintervention for failed antireflux surgery. Arch Surg 142:785–792CrossRefPubMed
10.
Granderath FA, Kamolz T, Schweiger UM, Pointner R (2002) Long-term follow-up after laparoscopic refundoplication for failed antireflux surgery: quality of life, symptomatic outcome, and patient satisfaction. J Gastrointest Surg 6:812–818CrossRefPubMed
11.
Lamb PJ, Myers JC, Jamieson GG, Thompson SK, Devitt PG, Watson DI (2009) Long-term outcomes of revisional surgery following laparoscopic fundoplication. Br J Surg 96:391–397CrossRefPubMed
12.
Pennathur A, Awais O, Luketich JD (2010) Minimally invasive redo antireflux surgery: lessons learned. Ann Thorac Surg 89:S2174–S2179CrossRefPubMed
13.
Furnee EJ, Draaisma WA, Broeders IA, Smout AJ, Gooszen HG (2008) Surgical reintervention after antireflux surgery for gastroesophageal reflux disease: a prospective cohort study in 130 patients. Arch Surg 143:267–274CrossRefPubMed
14.
Furnee EJ, Draaisma WA, Broeders IA, Gooszen HG (2009) Surgical reintervention after failed antireflux surgery: a systematic review of the literature. J Gastrointest Surg 13:1539–1549CrossRefPubMedPubMedCentral
15.
Telem DA, Altieri M, Gracia G, Pryor AD (2014) Perioperative outcome of esophageal fundoplication for gastroesophageal reflux disease in obese and morbidly obese patients. Am J Surg 208:163–168CrossRefPubMed
16.
Patterson EJ, Davis DG, Khajanchee Y, Swanstrom LL (2003) Comparison of objective outcomes following laparoscopic Nissen fundoplication vs laparoscopic gastric bypass in the morbidly obese with heartburn. Surg Endosc 17:1561–1565CrossRefPubMed
17.
Raftopoulos I, Awais O, Courcoulas A, Luketich JD (2004) Laparoscopic gastric bypass after antireflux surgery for the treatment of gastroesophageal reflux in morbidly obese patients: initial experience. Obes Surg 14:1373–1380CrossRefPubMed
18.
Varela JE, Hinojosa MW, Nguyen NT (2009) Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease. Surg Obes Relat Dis 5:139–143CrossRefPubMed
19.
Stefanidis D, Navarro F, Augenstein VA, Gersin KS, Heniford BT (2012) Laparoscopic fundoplication takedown with conversion to Roux-en-Y gastric bypass leads to excellent reflux control and quality of life after fundoplication failure. Surg Endosc 26:3521–3527CrossRefPubMed
20.
Kellogg TA, Andrade R, Maddaus M, Slusarek B, Buchwald H, Ikramuddin S (2007) Anatomic findings and outcomes after antireflux procedures in morbidly obese patients undergoing laparoscopic conversion to Roux-en-Y gastric bypass. Surg Obes Relat Dis 3:52–57CrossRefPubMed
21.
Kim M, Navarro F, Eruchalu CN, Augenstein VA, Heniford BT, Stefanidis D (2014) Minimally invasive Roux-en-Y gastric bypass for fundoplication failure offers excellent gastroesophageal reflux control. Am Surg 80:696–703PubMed
22.
Houghton SG, Nelson LG, Swain JM, Nesset EM, Kendrick ML, Thompson GB, Murr MM, Nichols FC, Sarr MG (2005) Is Roux-en-Y gastric bypass safe after previous antireflux surgery? Technical feasibility and postoperative symptom assessment. Surg Obes Relat Dis 1:475–480CrossRefPubMed
23.
Zhou T, Harnsberger C, Broderick R, Fuchs H, Talamini M, Jacobsen G, Horgan S, Chang D, Sandler B (2015) Reoperation rates after laparoscopic fundoplication. Surg Endosc 29:510–514CrossRefPubMed
24.
Davis CS, Baldea A, Johns JR, Joehl RJ, Fisichella PM (2010) The evolution of long-term results of laparoscopic antireflux surgery for the treatment of gastroesophageal reflux disease. JSLS 13:332–341CrossRef
Metadata
Title
Patterns of reoperation after failed fundoplication: an analysis of 9462 patients
Authors
Nabeel R. Obeid
Maria S. Altieri
Jie Yang
Jihye Park
Kristie Price
Andrew Bates
Aurora D. Pryor
Publication date
01-01-2018
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 1/2018
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-017-5682-y

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