Clinical Outcomes of Reoperation for Failed Antireflux Operations

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• 作者：Candice L. Wilshire ; MD ; Brian E. Louie ; MD ; ^{brian.louie@swedish.org" class="auth_mail" title="E-mail the corresponding author} ; Dale Shultz ; BS ; Zeljka Jutric ; MD ; Alexander S. Farivar ; MD ; Ralph W. Aye ; MD
• 关键词：ARS ; antireflux surgery ; ASA ; American Society of Anesthesiologists ; GERD ; gastroesophageal reflux disease ; HRQL ; Health Related Quality of Life ; IQR ; interquartile range ; MIS ; minimally invasive surgery ; QOL ; quality of life ; QOLRAD ; Quality of Life in Reflux and Dyspepsia ; Reop(1) ; one reoperation ; Reop(> ; 1) ; more than one reoperation ; REY ; Roux-en-Y
• 刊名：The Annals of Thoracic Surgery
• 出版年：2016
• 出版时间：April 2016
• 年：2016
• 卷：101
• 期：4
• 页码：1290-1296
• 全文大小：139 K

文摘

Up to 18% of patients undergoing antireflux operations will require reoperation. Authors caution that with each additional reoperation, fewer patients achieve satisfaction. The quality of life in patients who underwent revision operations was compared with patients who underwent primary antireflux operations to determine the effectiveness of revision operations.

Methods

We retrospectively reviewed patients who underwent revision after failed antireflux operations from 2004 to 2014. Patients were divided into two groups: first reoperation (Reop[1]) and more than one reoperation (Reop[>1]). For comparison, a control group of patients who underwent primary antireflux operations was included. Patients underwent quality of life assessment preoperatively and postoperatively.

Results

We identified 105 reoperative patients: 94 Reop(1), 11 Reop(>1), and 112 controls. The primary reason for failure was combined fundoplication herniation and slippage. Morbidity, mortality, and readmission rates were similar in all groups. Postoperative outcomes were improved in all groups but to a lesser degree in subsequent reoperations. Gastroesophageal Reflux Disease Health-Related Quality of Life: controls, 20.0 to 2.0; Reop(1), 26.5 to 4.0; and Reop(>1), 13.0 to 2.0. Quality of Life in Reflux and Dyspepsia: controls, 4.5 to 7.0; Reop(1), 3.7 to 6.7; and Reop(>1), 3.5 to 5.8. Dysphagia Severity Score: controls, 44.0 to 45.0; Reop(1), 36.0 to 45.0; and Reop(>1), 30.8 to 45.0.

Conclusions

Patients undergoing revision antireflux operations have improved quality of life, relatively normal swallowing, and primary symptom resolution at a median of 20 months postoperatively. However, patients who undergo more than one reoperation have lower quality of life scores and less improvement in dysphagia, suggesting that other procedures such as Roux-en-Y or short colon interposition, should be considered after a failed initial reoperation.