Long-term outcomes of reintervention for failed fundoplication: redo fundoplication versus Roux-en-Y reconstruction

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• 作者：Se Ryung Yamamoto (1)
  Masato Hoshino (1)
  Kalyana C. Nandipati (1)
  Tommy H. Lee (1)
  Sumeet K. Mittal (1)
  
• 关键词：Recurrent reflux ; Reoperative ; Redo fundoplication ; Roux ; en ; Y ; Failed fundoplication
• 刊名：Surgical Endoscopy
• 出版年：2014
• 出版时间：January 2014
• 年：2014
• 卷：28
• 期：1
• 页码：42-48
• 全文大小：435 KB
• 作者单位：Se Ryung Yamamoto (1)
  Masato Hoshino (1)
  Kalyana C. Nandipati (1)
  Tommy H. Lee (1)
  Sumeet K. Mittal (1)
  
  1. Department of Surgery, Creighton University School of Medicine, Omaha, NE, USA
  
• ISSN：1432-2218

文摘

Background Redo fundoplication (RF) is the mainstay of treatment for failed fundoplication. A subset of patients with failed fundoplication requires Roux-en-Y reconstruction (RNY) for symptom relief. The aim of this study was to compare the long-term subjective outcomes between RF and RNY in patients with failed fundoplication. Methods After Institutional Board Review approval, retrospective review of a prospective database identified 119 RF (mean?=?54.1?years, 78 women) and 64 RNY (mean?=?54.8?years, 35 women) patients who underwent reoperative surgery between December 2003 and September 2009. Data variables analyzed included demographics, esophageal manometry, 24-h pH study, type of procedure, perioperative findings, complications, pre- and postoperative symptom (heartburn, regurgitation, dysphagia, and chest pain) scores (scale 0-), and patient satisfaction score (scale 1-0). Patients with grade 2 and 3 scores were considered to have significant symptoms. Results Patients who underwent RNY had a significantly higher body mass index, higher mean number of risk factors, and higher preoperative severity of heartburn and regurgitation compared to the RF group. Of the 183 patients, long-term (>3?years) follow-up was available for 132 (89 RF and 43 RNY) patients. Symptom severity significantly improved after both procedures, with the exception of dysphagia in the RNY group. Overall, there was no significant difference in patients-satisfaction between the RF and RNY groups. In subset analysis, patients with morbid obesity, esophageal dysmotility, or ? risk factors have better satisfaction with RNY compared to RF (p?=?0.027, 0.031, and 0.045, respectively). Conclusions RF and RNY have equally good patient satisfaction at 3?years follow-up. RNY may have improved outcomes in patients who are morbid obese, have esophageal dysmotility, or have four or more risk factors.