Laparoscopic approaches to failed fundoplication for reflux

Abstract Background Scleroderma esophagus is a rare entity. Only few case reports of esophagectomy were done and reported for this condition. We are presenting this rare case of failed fundoplication and mesh repair with a diagnosis of GERD and hiatus hernia, which was found later on due to Scleroderma with Esophageal involvement. Methods 58 year old female admitted with dysphagia following laproscopic fundoplication with mesh repair of crura with a diagnosis of GERD and hiatus hernia.She presented with persistent vomiting and loss of weight.On evaluation, her Upper GI scopy revealed dilated esophagus with sluggish peristalisis. Since the patient had tightness of skin over the distal extremities, face and fish mouth appearance with thinning of nail, Skin biopsy was taken. The skin biopsy was reported to be scleroderma.The esophageal manometry demonstrated failed esophageal peristalisis with high normal LES pressure due to tight fundal wrap.The patient was treated with mesh remova, Transhiatal esophagectomy with gastric pull-up and cervical Anastomosis.Post operatively the patient was treated with hydrocholoroquine and predinisolone. Results The patient is free of dysphagia and is on regular follow up. Conclusion In case of failure, detailed evaluation including High resolution manometry (MII HRM) has to be done before doing laparoscopic fundoplication for GERD has to rule out uncommon and rare disorders of esophagus. Detailed clinical examination in GERD patients has to be done to rule out systemic disease like scleroderma.In case of failed fundoplication for GERD, patients have to investigated for the failure.So patients with incapacitating esophageal neuromotor disease, a more radical approach in the form of esophagectomy may be safer and more reliable than attempting another procedure and risk another failure. Disclosure All authors have declared no conflicts of interest.

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Laparoscopic Revision of Failed Fundoplication and Hiatal Herniorraphy

Journal of Laparoendoscopic & Advanced Surgical Techniques ◽

10.1089/lap.2008.0245 ◽

2009 ◽

Vol 19 (2) ◽

pp. 135-139 ◽

Cited By ~ 26

Author(s):

Constantine T. Frantzides ◽

Atul K. Madan ◽

Mark A. Carlson ◽

Tallal M. Zeni ◽

John G. Zografakis ◽

...

Keyword(s):

Failed Fundoplication

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Su1747 Reoperative Surgery for Failed Fundoplication - A Complex Operation Best Done Well the First Time

Gastroenterology ◽

10.1016/s0016-5085(15)33877-4 ◽

2015 ◽

Vol 148 (4) ◽

pp. S-1137

Author(s):

Max Schumm ◽

Matthew J. Frelich ◽

Kathleen L. Simon ◽

Matthew I. Goldblatt ◽

Andrew Kastenmeier ◽

...

Keyword(s):

Reoperative Surgery ◽

Failed Fundoplication ◽

Complex Operation ◽

First Time

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Reoperative Antireflux Surgery for Failed Fundoplication: An Analysis of Outcomes in 275 Patients

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2011.02.088 ◽

2011 ◽

Vol 92 (3) ◽

pp. 1083-1090 ◽

Cited By ~ 56

Author(s):

Omar Awais ◽

James D. Luketich ◽

Matthew J. Schuchert ◽

Christopher R. Morse ◽

Jonathan Wilson ◽

...

Keyword(s):

Antireflux Surgery ◽

Failed Fundoplication

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23 GASTRIC BYPASS AS REVISION SURGERY FOR FAILED FUNDOPLICATIONS

Diseases of the Esophagus ◽

10.1093/dote/doab052.23 ◽

2021 ◽

Vol 34 (Supplement_1) ◽

Author(s):

Reda Ezz

Keyword(s):

Revision Surgery ◽

Laparoscopic Fundoplication ◽

Revisional Surgery ◽

Cost Effective ◽

Recurrent Reflux ◽

Failed Fundoplication ◽

Redo Fundoplication ◽

Bile Gastritis ◽

Cost Effective Alternative

Abstract Laparoscopic fundoplication as anti-reflux technique has emerged and widely expanded as a cost effective alternative to life-long medical treatment in patients with gastroesophageal reflux disease (GERD). Long-term success rate ranges from 80–90% with this procedure, but side effects still exist even with experienced surgeons. Patients with a failed anti-reflux procedure are becoming a more common problem nowadays. Although most of these patients can be managed medically, still some of them will require revisional surgery. Methods We presented our experience from January 2015 to June 2019 facing cases of failed fundoplications. 59 cases with failed fundoplication requiring revision were included in the study. Redo fundoplications were decided preoperatively or intraoperatively to be difficult or unsafe to be done for these cases. Revision surgery for these cases was done using either distal gastrectomy and RY gastro-jejunostomy (22 cases) when the hiatal dissection was not feasible or unsafe due to obscure anatomy or Truncal vagotomy and RY gastro-jejunostomy (37 cases) when the hiatal dissection was easy and feasible. Results Laparoscopy was used in 49 cases and was successfully completed in 42cases (%) and 7conversion (%). Improvement of symptoms: Recurrent reflux or dysphagia was noted in 19 cases (32%) and complete disappeared in 26 cases (44%). One case had leak from the GJ and another one got hematemesis. Both cases were managed conservatively. Nine patient (15%) had bile gastritis with abdominal pain. Five patients (8.5%) complained of dumping symptoms. No mortality was recorded. Conclusion RY gastro-jejunostomy for failed fundoplications is a valid, feasible surgical option when redo fundoplication is difficult to be done or if associated with possible or expected complications.

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