Surgical management for common complications after antireflux surgery | ||
| The Egyptian Journal of Surgery | ||
| Volume 21, Issue 2, April 2002, Pages 877-889 PDF (7.8 M) | ||
| Document Type: Original Article | ||
| DOI: 10.21608/ejsur.2002.401162 | ||
| Authors | ||
| Ayman A. Talaat1; Ahmed Alaa1; Tarek I. Ouf1; Mounir M. Abo ElEla1; Hassan Galal Mourad2 | ||
| 1Departments of General Surgery, Faculty of Medicine, Ain Shams University | ||
| 2Departments of Radiodiagnosis, Faculty of Medicine, Ain Shams University | ||
| Abstract | ||
| Introduction: Complications after an antireflux procedure are considered when the patient is unable to swallow normally, has recurrence or persistence of reflux symptoms and experiences upper abdominal discomfort during and after meals. The dramatic increase in the number of patients undergoing antireflux surgery and consequently their complications match the advances in the conventional operation and the recent application of laparoscopic fundoplication. The assessment of these symptoms and the selection of patients who need further surgery is a challenging problem. A critical functional assessment of these patients before re-operation is crucial to its success. Objective: To define the common technical defects in operations for gastro-esophageal reflux disease (GERD) responsible for late postoperative complications and their management. Patients and methods: This study was a randomized retrospective study that included 20 patients who presented with various complications following open and laparoscopic antireflux procedures. The study was conducted in Ain Shams University Hospitals, between January 1998 and January 2002. All patients were submitted to radiographic, endoscopic and manometric studies to assist in planning the ideal operative option and to assess the result of the operation postoperatively. The intervention was carried out via open abdominal approach either upper vertical midline or bilateral subcostal incisions. Results: The most common presentation was dysphagia in 14 cases (70%): Tight crura were found to be the cause in 4 patients (20%), tight wrap in 4 patients (20%), torsion of lower esophageal segment in 5 patients (25%) and achalasia in 1 patient (5%). Three patients (15%) presented with reflux: Disruption of the wrap was found in 2 patients (10%), and slipped stomach in 1 patient (5%). The remaining 3 patients (15%) presented with gastric dilatation resulting from pyloroduodenal deformity in 1 patient (5%) and inadvertent vagi severance in 2 patients (10%). Cure was achieved in 16 patients (80%), improvement of symptoms in 2 patients (10%), and dysphagia persisted in 2 patients (10%) suffering motility disorder. Conclusion: A further operation is required in a small proportion of patients who have had prior antireflux surgery. This has a surprisingly good chance for success in properly evaluated patients. | ||
| Keywords | ||
| Dysphagia; failed antireflux surgery; Toupet fundoplication; Floppy Nissen fundoplication | ||
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