Back to 2025 Abstracts
IMPACT OF DIFFERENT ANATOMIC FAILURE PATTERNS OF ANTIREFLUX SURGERY ON DISTAL ESOPHAGEAL PH MONITORING AND GASTROESOPHAGEAL REFLUX SYMPTOMS
Inanc Sarici
*1,3, Sven Eriksson
1,3, Naveed Chaudhry
1, Mostafa Abdelhalim
1, Kirsten Newhams
1, Ping Zheng
1, Shahin Ayazi
1,2,31Foregut Division, Surgical Institute, Allegheny Health Network, Pittsburgh, PA; 2Department of Surgery, Drexel University, Philadelphia, PA; 3Chevalier Jackson Research Fellowship, Esophageal Institute, Western Pennsylvania Hospital, Allegheny Health Network, Pittsburgh, PA
Introduction: Anatomic failure of the antireflux barrier and abnormal distal esophageal acid exposure are strongly correlated. However, there is a paucity of objective data with different failure patterns after antireflux surgery (ARS). This study aims to assess the impact of anatomic failure patterns on distal esophageal pH-monitoring and associated symptoms.
Methods: Patients who underwent ARS between 2013 and 2023 were evaluated for anatomical failure. Patients with failure then underwent 48-hour wireless pH monitoring. Failure patterns included herniated, disrupted, herniated-and-disrupted, and slipped fundoplication, with results presented in this order. Postoperative GERD–HRQL scores, PPI use, endoscopy, pH-monitoring, and need for revisional surgery data were compared between failure pattern groups.
Results: During the study period, 2191 patients underwent ARS. At a mean (SD) of 74(80) months 278 (12.7%) had anatomic failure. Herniated fundoplication was the most common failure pattern (38.9%); slipped fundoplication was the least (5%). Demographic and preoperative clinical factors were similar between groups (Table).
Postoperative GERD-HRQL scores and subscores were similar between groups. However, dysphagia was lowest with slipped fundoplication [2.0(0.0-4.0)-vs-2.0(0.0-3.0)-vs-2.0(0.0-3.0)-vs-0.5(0.0-2.0), p=0.048]. Abnormal DeMeester score (>14.7) was highest with herniated-and-disrupted fundoplication (42.6%-vs-28.1%-vs-64.6%-vs-42.9%, p<0.001). Additionally, Grade C/D esophagitis was more common in the slipped followed by the herniated-and-disrupted group (4.5%-vs-1.8%-vs-13.1%-vs-14.3%, p=0.018).
In a subgroup of 160 (57.5%) patients who underwent revisional surgery, obesity differed among failure patterns, with the highest rate in herniated fundoplication (53.1%-vs-44.4%-vs-28.2%-vs-33.3%, p=0.034). However, herniated-and-disrupted fundoplications were most likely to undergo revision (45.4%-vs-47.4%-vs-78.8%-vs-42.9%, p<0.001).
Conclusion: Anatomic failure occurred in 12.7% of patients 74 months after ARS. Herniation was the most common failure pattern. Obesity was associated with herniation in patients who underwent revisional surgery. Despite similar symptoms between patterns, disrupted-and-herniated fundoplication had the worse distal esophageal acid exposure and were most likely seek revision.
Back to 2025 Abstracts
