The Spectrum of Surgical Remediation of Transoral Incisionless Fundoplication-Related Failures.

Abstract

AIM:

To evaluate outcomes of surgical remediation for symptomatic or anatomic failure after a transoral incisionless fundoplication (TIF).

METHODS:

This retrospective study was performed on 11 patients who underwent a remedial operation following TIF failure between June 2011 and September 2016 at the Mayo Clinic in Florida for persistent foregut symptoms. Upper gastrointestinal workup characterized 1 patient as having normal post-TIF anatomy and 10 as having anatomic failure. Ambulatory pH testing was performed in 7 patients and was abnormal in all. All patients underwent a laparoscopic takedown of the prior endoscopic fundoplication and removal of all accessible polypropylene T-fasteners.

RESULTS:

All patients had esophageal salvage and have not required a reoperation. Anatomical findings included hiatal hernia (7), esophageal diverticulum (2), hiatal mesh erosion of esophagus (1), long-segment esophageal stricture (1), and normal anatomy (1). Remedial operations included laparoscopic explant of fasteners in all patients with conversion to fundoplication (7), resection/imbrication of esophageal diverticulum (2), Heller myotomy (1), and mesh explant and complex esophageal repair (1). Mean operative time was 177 minutes and median length of stay 3 days (range 2-13 days). At mean follow-up of 10.7 months (range 1-42 months), 7 patients had persistent complaints. Esophagogastroduodenoscopy was repeated in these 7 patients and was normal (n = 3), mild stenosis requiring dilation (n = 2), Los Angeles grade B esophagitis (n = 1), and Barrett's esophagus (n = 1).

CONCLUSION:

Anatomic distortion of the distal esophagus after TIF can be significant, making subsequent operations complex. After remedial surgery, few patients will continue to have troublesome symptoms such as dysphagia.

• Authors: Ruchir Puri, C Daniel Smith, Steven P Bowers
• Journal: Journal of laparoendoscopic & advanced surgical techniques. Part A (J Laparoendosc Adv Surg Tech A) Vol. 28 Issue 9 Pg. 1089-1093 (Sep 2018) ISSN: 1557-9034 [Electronic] United States
• PMID: 29768079 (Publication Type: Journal Article)

Topics

• Adult
• Aged
• Diverticulum, Esophageal (surgery)
• Endoscopy, Gastrointestinal
• Esophageal Sphincter, Lower (surgery)
• Esophageal Stenosis (etiology, surgery)
• Esophageal pH Monitoring
• Female
• Fundoplication (adverse effects, methods)
• Gastroesophageal Reflux (surgery)
• Hernia, Hiatal (surgery)
• Humans
• Laparoscopy
• Length of Stay
• Male
• Middle Aged
• Myotomy
• Operative Time
• Postoperative Complications (etiology, surgery)
• Reoperation
• Retrospective Studies
• Surgical Mesh (adverse effects)
• Treatment Failure