Introduction: Nearly 15% of patients after laparoscopic antireflux surgery experience recurrence of symptoms or develop new gastrointestinal symptoms. Some of them require redo procedures. It can be demanding to reveal anatomical failure after previous fundoplication.
Aim: To present a method which assists in recognition of anatomical failures after Nissen fundoplication.
Material and methods: Five patients with previous laparoscopic Nissen fundoplication and severe gastrointestinal symptoms were included in this study. During the esophagogastroduodenoscopy (EGDS) two radiopaque metal clips were placed to mark the Z-line ("clips-marked Z-line" - CMZL). It was done to achieve precise visualization of the gastroesophageal junction area in the video contrast investigation. Distinctions between conclusions after the EGDS, ordinary video contrast investigation, video contrast investigation with CMZL and intraoperative findings were analyzed.
Results: All patients underwent laparoscopic refundoplication with good postoperative results. There were 4 cases misdiagnosed by contrast investigation without clips and four cases misdiagnosed by EGDS. Endoscopic clipping helped to recognize correctly all anatomical failures.
Conclusions: Applying CMZL as a routine investigation before redo fundoplication can reduce frequency of misdiagnosis and help to perform redo fundoplication in appropriate patients, but it requires further studies on larger cohorts of patients.
Keywords: endoscopic clipping; failed fundoplication; laparoscopic fundoplication; redo surgery; slipped Nissen.
Laparoscopic Refundoplication With Prosthetic Hiatal Closure for Recurrent Hiatal Hernia After Primary Failed Antireflux SurgeryFA Granderath et al. Arch Surg 138 (8), 902-7. PMID 12912751. - Clinical TrialLaparoscopic refundoplication with prosthetic hiatal closure is a safe and effective procedure for preventing recurrent intrathoracic wrap herniation, with good to excell …
Reoperative Antireflux Surgery for Failed Fundoplication: An Analysis of Outcomes in 275 PatientsO Awais et al. Ann Thorac Surg 92 (3), 1083-9; discussion 1089-90. PMID 21802068.Redo antireflux surgery can be performed safely in experienced centers with outcomes that are similar to published open results. Complete takedown and reestablishment of …
Anatomical Deformities After Laparoscopic Antireflux SurgeryI Braghetto et al. Int Surg 89 (4), 227-35. PMID 15730105.Laparoscopic Nissen, Nissen-Rossetti, cardial calibration with gastropexy, and other modifications are the procedures commonly used for surgical treatment of gastroesopha …
[Surgical Treatment of Recurrent Gastroesophageal Reflux]C Iascone et al. Ann Ital Chir 66 (5), 615-20. PMID 8948798. - ReviewFrom 1972 to 1994, 66 patients underwent 67 Belsey MK IV antireflux repairs in our unit. Fifteen of the 67 patients or 22% had previously undergone antireflux surgery (10 …
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