Abstracts
1999 Digestive Disease Week

# 2110 CAUSES OF REOPERATION AFTER LAPAROSCOPIC NISSEN FUNDOPLICATION.
M Anvari, St. Joseph's Hosp and McMaster Univ, Hamilton, ON Canada; T Boghossian, McMaster Univ, Hamilton, ON Canada

Laparoscopic Nissen Fundoplication (LNF) is rapidly becoming the procedure of choice for surgical treatment of chronic GERD. We retrospectively analyzed the causes of reoperation among 566 patients who underwent LNF teritary centre by a trained surgeon over a 6 year period. The causes of reoperation were divided into 3 groups: i. early complication (£ 30 days); ii. late complication >30 days) and iii. patients with recurrent reflux symptoms. Results: 16 patients (2.8%) required reoperation. 5 patients required more than 1 reoperation. All patients who required more than one surgery had recurrent paraesophageal hernia. Paraesophageal hernia (PEH) was the cause of reoperation among all 5 patients with late complications and 4 of 5 patients who presented with early complications. An esophageal leak was the other cause of early reoperation. The repair of all 9 PEH's were attempted laparoscopically but 2 required conversion. Of the 7 laparoscopic repairs of PEH, 5 patients had recurrence and required further surgery, and eventually open surgery to completely take down the previous wrap, repair the hernia and redo the fundoplication. Of the 6 patients with recurrence of reflux symptoms, 5 had laparoscopic and 1 had open redo fundoplications. All redo fundoplications for recurrent reflux symptoms have been successful. Conclusion: The rate of reoperation after LNF is low. Paraesophageal herniation of the stomach is the most common cause of reoperation and unless dealt with appropriately can lead to more repeat surgery. Most redo fundoplications for recurrence can be done successfully using the laparoscopic approach.

Causes of	Early ( £ 30 d)	Late ( >30d)	Recurrence
Reoperation	Complication	Complication	of Symptoms
Number	5	5	6

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