Reoperations for Esophagitis Following Failed Antireflux Procedures

Abstract

The results of all operations for recurrent esophagitis were studied and reviewed. Patients (55) had undergone a total of 61 previous operations for reflux (initial operation: Hill, 9; Nissen, 30; Allison, 8; Thal, patch 3; Belsey, 10; other, 1). Eleven patients underwent a Hill procedure (indications: intractable gas-bloat syndrome, 4 patients, esophagitis, 7 patients). Two developed recurrent esophagitis (18%). Seventy-eight percent had satisfactory results (mean follow-up 24 mo.), and there were no deaths. Three individuals had a transabdominal fundoplication. One patient was lost to follow-up while the other 2 had satisfactory results (follow-up, 1 and 6 yr). Twenty-nine patients were subjected to a transthoracic fundoplication, with 2 deaths (7%). One patient (4%) was lost to follow-up at 9 mo.; mean follow-up was 44 mo. Eighty-six percent had satisfactory results. The sole poor result occurred in a scleroderma patient who ultimately required colon interposition. Twelve patients underwent a Thal-Nissen procedure. One patient was lost to follow-up (8%), while another with scleroderma had an unsatisfactory result (8%); 83% had satisfactory results. The mean follow-up was 70 mo. There were no deaths. Overall, 80% of patients subjected to reoperation had satisfactory results. Mortality was 44%. Reoperations for gastroesophageal reflux constitute an effective means of controlling recurrent esophagitis and compare favorably with primary operations in both mortality and success rate.