Abstracts
2002 Digestive Disease Week

# 100251 Abstract ID: 100251 Laparoscopic Refundoplication with Prosthetic Hiatal Closure for Recurrent Hiatal Hernia after Primary Failed Antireflux Surgery
Frank A Granderath, Ursula M Schweiger, Thomas Kamolz, Rudolph Pointner, 5700 Zell am See, Austria

Background: One of the most occuring complication after laparoscopic antireflux surgery is estimated to be the intrathoracic wrap herniation. Therefore, in up to 5% of patients, revisional surgery is necessary. Aim of this prospective study was to evaluate surgical outcome in patients who underwent laparoscopic refundoplication for postoperative intrathoracic wrap herniation using a polypropylene-mesh for hiatal closurefor a complete follow-up period of one year. Patients and methods: Between January 1998 and May 2000, a group of 24 consecutive patients underwent laparoscopic refundoplication for recurrent reflux, dysphagia or a combination of both. The underlying morphological complication in all patients was a postoperative intrathoracic wrap herniation. Therefore, redo-surgery was performed using a 6x12 cm polypropylene-mesh for hiatal closure. Preoperative and postoperative data including esophagogastroduodenoscopy, esophageal manometry, 24-hour-pH monitoring and barium swallow (kinematographic x-ray) were prospectively reviewed for a complete follow-up period of 1 year. Results: All redo-procedures were completed laparoscopically. There were no intraoperative complications. Twenty-one patients underwent laparoscopic Nissen fundoplication, in 3 patients a laparoscopic Toupet fundoplication was performed. Previous antireflux procedures were in 5 patients an open Nissen fundoplication, in 15 patients a laparoscopic Nissen fundoplication and in 4 patients a laparoscopic Toupet fundoplication. Postoperatively, one patient suffered from severe dysphagia and had to undergo pneumatic dilatation. For a mean follow-up period of 26 months ( range 3 months to 44 months) no patient developed a recurrent hiatal hernia with or without intrathoracic wrap herniation. The mean lower esophageal sphincter pressure increased significantly at 3 months (12.2 mmHg) and 1 year (11.9 mmHg) after redo-surgery. The mean DeMeester score decreased significantly from 50.51 points preoperatively to 16.8 at 3 months and 14.7 at 1 year after redo-surgery. Conclusion: Laparoscopic refundoplication with prosthetic hiatal closure is a safe and effective procedure to prevent recurrent intrathoracic wrap herniation with good to excellent functional outcome for a complete follow-up period of one year.