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LONG-TERM OUTCOMES OF FAILED FUNDOPLICATION: A 10-YEAR ANALYSIS OF FACTORS CONTRIBUTING TO REDO FUNDOPLICATION
Andric Perez-Ortiz
*1, Gonzalo Torres-Villalobos
2, Ana Sandoval Mussi
1, Grece Daniela Salinas García
3, Jorge Gerardo Obregón Méndez
1, Martin Vega de Jesús
1, Cesar Decanini
11Department of Surgery, Centro Medico ABC, Mexico City, Mexico City, Mexico; 2Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico; 3Hospital Espanol, Mexico City, CDMX, Mexico
Introduction: Laparoscopic fundoplication is the mainstay surgical treatment for refractory gastroesophageal reflux disease. A significant proportion of patients, up to 30%, experience fundoplication failure (FF), needing reintervention. There is no consensus on the optimal treatment option for FF cases, and evidence assessing risk factors for failure is lacking. Here, we aimed to examine the main risks that are included in preoperative stage, the patient, and surgical-related factors with significance in FF.
Methods: We analyzed a cohort of 3,094 fundoplications, including 232 FF cases undergoing surgical repair from 2014 to 2024. We extracted clinical, demographic, and surgical data from electronic medical records and operative reports. We assessed survival free of FF across risk factors with Cox regression models in R v.4.2.2.
Results: Reoperation rates ranged from 5.2% to 18.8% per year. The most common symptoms of FF included upper abdominal pain (50.47%), regurgitation (47.64%), and heartburn (43.87%). Cases managed by surgeons with a history of at least ten reoperation procedures performed during cohort follow-up had significantly higher survival from FF than less experienced surgeons (P = 0.011) (T50 for first reoperation six vs. three years, respectively) (Figure 1). Prolonged hospital stay, exceeding three days after fundoplication, increased the risk of reoperation and decreased survival free from FF (P = 0.076, T50 for first reoperation five vs. three years, respectively). The interval between reoperations, i.e., freedom from FF, decreased with an increasing number of previous procedures (P = 0.0001) (Figure 2). Nissen fundoplication was the most common initial procedure after failure, while subsequent reinterventions often involved alternative techniques such as Dor, Toupet, or gastrostomy. There was no effect of mesh-augmentation in survival from FF.
Conclusions: Our study of patients undergoing redo fundoplication underscores the significant reoperation rate. This finding emphasizes the pressing need for improved patient selection and surgical techniques. We evidence that prolonged hospital stay following initial surgery and surgeon experience were significantly associated with the risk of FF and the need for reoperation.
Figure 1
Figure 2
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