Previous Failed Antireflux Surgery

Antireflux surgery is the procedure to restore the function of the lower esophageal sphincter (the valve between the esophagus and the stomach) and to prevent the reflux of acid and bile (non-acidic juice) from the stomach into the esophagus. The most common procedure to restore the function of the lower esophageal sphincter is a minimally invasive procedure called laparoscopic Nissen fundoplication.

Following an antireflux surgery, if patients present with recurrent symptoms (the same symptoms that were present prior to surgery), or if they present with new reflux-related symptoms, failure of the procedure should be considered.

Patients should be selected very carefully and should have a complete work-up prior to an antireflux procedure.

The majority of failed antireflux procedures are the result of inadequate patient selection, or incomplete diagnostic work-up prior to surgery and failure in surgical techniques.

The fundoplication (wrapping of the stomach around the esophagus) can be:

• Too tight
• Too lose
• Twisted
• Herniated into the chest
• Slipped (the stomach is wrapped around itself instead of around the esophagus)

What Is a Successful Antireflux Procedure?

Predictors of a successful antireflux procedure include:

• Positive esophageal pH study (showing that there is acid inside the esophagus)
• The typical symptoms of reflux, such as heartburn and/or regurgitation
• Response to medical therapy

After anti-reflux surgery, if a patient experiences recurrent symptoms (the same symptoms that were present prior to surgery), or new onset reflux-related symptoms, they should see their doctor.

To diagnose failed surgery, your doctor should:

• Assess your symptoms prior to surgery
• Review all the studies that were performed prior to surgery
• Review the surgery itself
• Obtain a thorough assessment of symptoms and onset of symptoms following surgery.

Subsequently, a full work-up should be obtained which includes:

• Videoesophagram
• Esophageal motility study
• Esophageal pH assessment
  • 24-hour pH study
  • 48-Hour Esophageal pH testing with the Bravo capsule wireless system
• Upper endoscopy

The “redo” operation should address the exact cause of failure and should be performed in specialized, high-volume centers by experienced surgeons.

A first-time redo antireflux surgery can be performed by minimally invasive approach.

The most common procedure will be a redo laparoscopic Nissen fundoplication.

The procedure may need to be done via a laparotomy (an incision in the abdomen) in selected patients. If multiple surgeries have failed, an esophagectomy (esophageal replacement) may be required.