%0 Evaluation Study
%T Laparoscopic redo anti-reflux surgery: Case-series of different presentations, varied management and their outcomes.
%A Nageswaran H
%A Haque A
%A Zia M
%A Hassn A
%J Int J Surg
%V 46
%N 0
%D Oct 2017
%M 28821410
%F 13.4
%R 10.1016/j.ijsu.2017.08.553
%X <B>BACKGROUND: </B>A minority of patients undergoing surgery for refractory gastroesophageal reflux disease (GORD) will require revision antireflux surgery ("redo-ARS") for persistent symptoms or complications. Although a repeat minimally invasive procedure for revision may be technically challenging due to post-operative changes, studies are beginning to show favourable data for the laparoscopic approach.<BR><B>METHODS: </B>From a single institution 41 consecutive cases of laparoscopic redo-ARS performed by the same surgeon were classified by mode of presentation to analyse their intra-operative findings, management and post-operative outcomes. Cases were classified as either early, emergency or late.<BR><B>RESULTS: </B>There were 12 early, 4 emergency and 25 late redo-ARS cases. Complete resolution of symptoms, using the criteria of less than weekly symptoms and off all anti-reflux medications, were acquired in 6 (50%), 2 (50%) and 16 (64%) patients within the early, emergency and late groups respectively. Overall morbidity following revision was 7.3% with no mortality. There were no open conversions.<BR><B>CONCLUSIONS: </B>Although fewer patients will achieve complete resolution of symptoms as compared with outcomes following primary ARS, laparoscopic revision of ARS is a safe and effective approach for the revision of anti-reflux surgery in the early, emergency and elective settings.