Grover and you can Kothari (2015) reported that diligent fulfillment that have no. 1 anti-reflux operations was highest, however, a small percentage regarding customers sense recurrent reflux and you may dysphagia, requiring re-process. The big anatomic factors behind failed fundoplication is actually tucked fundoplication, inability to understand an initial esophagus, and you may problems with the newest tie. Minimally intrusive functions has been usual for those methods. Choices for operations were redo fundoplication which have hiatal hernia resolve if called for, conversion process in order to RNY physiology, otherwise, because the a past hotel, esophagectomy. This remark failed to promote people logical research; although not, they did mention the research by the Awais et al (2008) and you will Makris ainsi que al (2012).
The brand new article authors mentioned that transformation to RNY anatomy had a high success rate, making it approach a significant option on safely picked patient
Awais and co-workers (2008) stated that intractable GERD after prior anti-reflux operation presents a difficult challenge. These investigators examined the role of Roux-en-Y near esophago-jejunostomy (RNYNEJ) in the management of intractable reflux symptoms after prior anti-reflux surgery. Between , a total of 25 patients with GERD after anti-reflux surgery underwent RNYNEJ. The end-points evaluated were improvement in GERD symptoms using the GERD-Health Related Quality of Life (HRQL) scale, overall patient satisfaction, overall patient weight loss, and improvement of co-morbid conditions. There were 4 men and 21 women (mean age of 51 years; range of 35 to 74); 72 % had a BMI of greater than 30; 44 % had more than 1 anti-reflux surgery and 40 % had a previous Collis gastroplasty. The peri-operative mortality was 0 %; 6 patients (24 %) developed major post-operative complications, including anastomotic leak chodit s nÄ›kÃ½m compatible partners (n = 2) and Roux-limb obstruction (n = 1). The median length of stay (LOS) was 6 days; 80 % of the patients reported satisfaction at mean follow-up time of 16.5 months. Their BMI reduced from 35.8 to 27.7 (p < 0.001); 73 % of co-morbid conditions were improved and the GERD HRQL score improved from 29.9 to 7.3 (p < 0.001). The authors concluded that the RNYNEJ for persistent GERD after prior anti-reflux surgery was technically challenging with significant morbidity. However, the majority of the patients reported satisfaction with significant improvement in symptoms. Many patients had associated benefits of weight loss and improvement in co-morbid conditions. They stated that RNYNEJ should be considered as an important option for the treatment of intractable GERD after prior anti-reflux surgery, particularly in the obese. Moreover, they stated that there is a need to further investigate and analyze patient variables that influence outcomes because this may help physicians/surgeons to better select patients for a particular type of operation. They noted that these variables need to be prospectively studied to define optimal candidates, and further work is needed for optimizing patient selection. This was a small study (n = 25) with short-term follow-up (mean of 16.5 months).
There was an increase in reported nausea (0-1, p < 0
Makris and colleagues (2012) stated that revisionary fundoplication is the mainstay of treatment for failed previous fundoplication, but is not always feasible. These investigators reported their experience with use of short-limb RNY reconstruction for failed anti-reflux procedures. Prospectively collected data were retrospectively analyzed for morbidity, mortality, pre- and post-procedure symptom scores (scale 0 to 3), BMI, and patient satisfaction (scale 1 to 10). A total of 72 patients with 1 to 4 (median 1) previous anti-reflux procedures underwent RNY reconstruction, either to gastric pouch (n = 64) or to the esophagus (n = 8). There were 37 laparoscopic, 24 open abdominal, and 2 combined thoracic-abdominal procedures; 9 additional patients underwent conversion from laparoscopy to open surgery. Mean follow-up of 20.7 months (± 12.9 months) was available in 63 (88 %) patients. The overall median scores for heart-burn, regurgitation, dysphagia, chest pain, and nausea were 0 or 1. There were 72 major and minor complications noted that affected 33 (46 %) patients, with no in-hospital or 30-day mortality observed. The most common complications were anastomotic strictures, bowel obstructions, respiratory complications, and dumping. Mean post-operative BMI was 24.6 (± 4.4) kg/m(2) compared with pre-operative BMI of 31.4 (± 6.1) kg/m(2). Mean reported satisfaction score was 8.2 (± 2.1), and 89 % of the patients would recommend the procedure to a friend. Pre- and post-operative symptoms could be compared in 57 patients, and significant decrease in median symptom scores for heart-burn (2-0, p < 0.05), regurgitation (1-0, p < 0.05), and dysphagia (2-0, p < 0.05) was confirmed. 05). The authors concluded that short-limb RNY reconstruction was an effective remedial procedure for a subset of patients with failed anti-reflux surgery, but morbidity was significant. Moreover, they stated that the main drawback of this study was retrospective studies performed on prospective databases. Furthermore, they stated that studies with longer follow-up are needed to validate these findings.