HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): George Kanellopoulos Mark L. Field John P. Duffy Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Khan, O. A. Articles by Duffy, J. P. Search for Related Content PubMed PubMed Citation Articles by Khan, O. A. Articles by Duffy, J. P. Related Collections Esophagus - other

Eur J Cardiothorac Surg 2004;26:875-880
© 2004 Elsevier Science NL

Redo antireflux surgery—the importance of a tailored approach

^a Thoracic Unit, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK
^b GI Physiology Unit, Nottingham City Hospital, Hucknall Road, Nottingham NG5 1PB, UK

Received 18 January 2004; received in revised form 1 June 2004; accepted 23 July 2004.

^* Corresponding author. Tel./fax: +44-115-969-1169. (E-mail: omarkhan{at}iname.com).

Objective: Although several studies have examined early outcome following redo antireflux surgery, there is little data on the long-term efficacy of these procedures. We reviewed our experience of these operations in order to assess the long-term results which can be achieved by choosing redo antireflux procedures based on the results obtained from pre-operative oesophageal function testing. Methods: The case notes of 26 patients who underwent a repeat antireflux procedure between 1981 and 2000 were reviewed. Clinical history, examination, endoscopy, pH studies, oesophageal manometry and video barium contrast studies were performed on all patients prior to re-operation. In all cases, a standardised pre-formulated algorithm, based on the results of the pre-operative oesophageal function tests, was used to determine the choice of surgical procedure. Post-operatively, patients were classified into three groups: Group A (those with no symptoms), Group B (symptoms controlled by medication) and Group C (symptoms refractory to medical treatment). Patients in Groups B and C underwent repeat oesophageal function studies. Results: In all cases, the indication for re-operation was gastro-oesophageal reflux symptoms refractory to medical treatment. Twenty-one patients (81%) underwent a left thoracotomy, of whom 11 patients (42%) underwent a gastroplasty. The mean follow-up period was 8.27 years (range 1.5–19.8 years), after which 14 patients (54%) were classified as Group A; 10 patients (38%) as Group B; and 2 patients (8%) as Group C. Within Groups B and C, manometry showed that re-operation had increased basal lower oesophageal sphincter pressure (4.6 vs 12.7mmHg, pre- vs post-operative P=0.03), and in all, but one case pH studies showed no evidence of recurrent acid reflux. Conclusions: Redo antireflux surgery can provide complete symptomatic relief in approximately 50% of patients and symptomatic improvement over 90% of patients. We advocate a tailored approach in the selection of re-operative procedures based on the results of pre-operative oesophageal function testing.

This article has been cited by other articles:

				E. J. B. Furnee, W. A. Draaisma, I. A. M. J. Broeders, A. J. P. M. Smout, and H. G. Gooszen Surgical Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease: A Prospective Cohort Study in 130 Patients Arch Surg, March 1, 2008; 143(3): 267 - 274. [Abstract] [Full Text] [PDF]