European Journal of Cardio-Thoracic Surgery, Vol 10, 225-231, Copyright © 1996 by European Association for Cardio-thoracic Surgery
Reoperation after failed antireflex surgery. Review of 101 cases
FH Ellis Jr, SP Gibb and GJ Heatley
Division of Cardiothoracic Surgery, Deaconess Hospital and Harvard Medical School, Boston, MA 02115, USA.
Between January 1970 and July 1994, 101 patients underwent reoperation for
a failed antireflux procedure. These patients had previously had 160 upper
gastrointestinal tract operations, usually a Nissen fundoplication or one
of its modifications (87). The chief reason for failure of the original
antireflux procedure was faulty surgical technique (65). An incorrect
diagnosis accounted for most of the remaining failure (22). Of patients who
had follow-up studies, 80% were improved by reoperation, which consisted of
takedown or refashioning of the original wrap in the majority of patients
(63). A more radical approach is justified after two failed reoperations.
Our current preference is for vagotomy, antrectomy, and Roux-en-Y diversion
coupled, when indicated, with resection of the esophagogastric junctional
area.
