What is Redo or Revision Antireflux Surgery?
A failed Antireflux Surgery occurs when a patient develops severe GERD symptoms or has other complications after having a prior or initial Antireflux Surgery. Redo or Revison Antireflux Surgery is laparoscopically performed to correct the problems that may have resulted from the first or initial Antireflux procedure.
Who needs Redo or Revision Antireflux Surgery?
Recurring symptoms of Severe GERD are the earmark of a Failed Antireflux Surgery. These symptoms may include choking, coughing, aspiration pneumonia, asthma, voice changes, recurrent sinusitis, or heartburn. In some people these symptoms are particularly worse at night.
If a patient’s hernia comes back, and the wrap slips up above the diaphragm, they can develop what’s called a paraesophageal hernia. A paraesophageal hernia is at risk for strangulation. They can produce symptoms of chest pain or diffulculty swallowing called dysphagia. Another form of failure is a Slipped Nissen Fundoplication, where the stomach slips above the wrap.
While the Redo or Revision Surgery is normally performed laparoscopically, safety is the most important concern. In rare cases safety dictates that a laparotomy or a bigger incision is necessary.
What are the steps in Severe GERD Revision Surgery?
Determining the Cause of Failed GERD Surgery
In order to repair or revise the failed Antireflux Surgery studies are done to determine what part or parts of the procedure have failed. Typical studies include a barium swallow, EGD, esophageal manometry or pH studies. Necessary studies are individualized. Redo or Revison Antireflux Surgery is laparoscopically performed to correct the issues that may have resulted from the first or initial Antireflux procedure Below are some of the steps that may be taken during Redo Antireflux Surgery.
Repairing the Hiatal Hernia
If a hiatal hernia is present or has recurred the hernia will be repaired. Your surgeon will place the stomach back into its correct position, which is below the diaphragm. Once it’s in place, the hole created by the hernia will be sutured closed. A special surgical mesh will then be placed to prevent the hernia from returning. If this is all that is needed, the procedure may end here.
Performing the Wrap
If necessary, the next step in Redo Antireflux Surgery is to reconstruct the LES making it function stronger as a valve. This is accomplished through a procedure called a procedure called a fundoplication or a wrap. Your surgeon will mobilize the fundus of the stomach, which is the upper portion of the stomach up near the diaphragm, and wrap it around the esophagus. This increases the pressure zone of the valve and prevents reflux. If no other steps are needed, the procedure may end here.
Different Wrap Methods
If the method or location of the wrap used in the initial procedure contributed to the Failed GERD Surgery, your surgeon will then perform the wrap using the correct method.
There are different wrap methods your surgeon may choose depending on your particular condition. A complete wrap, which is a 360 degree circle, is called a Nissen fundoplication. Another type of wrap is the Toupet or a partial wrap, which is between 270 and 300 degree wrap, and that type is used for people who have weak esophaguses. And that’s called a Toupet or a partial. Other types of wrap methods exist, but all fundoplication methods are intended to increase the pressure zone of the valve.
Recovery from Redo or Revision AntiReflux Surgery is almost identical to the recovery process after the initial Antireflux Surgery. Redo Antireflux Surgery is usually performed as a 23 hour stay (out patient procedure). We believe an overnight observation assures that the patient has good pain control. Your doctor will prescribe a special diet and certain activity modifications that will help ensure the best results from your procedure. Many patients lose 10- 12 pounds after surgery due to the diet change. Rest is an important part of recovery after this procedure. Your doctor will recommend waiting at least a week after surgery before performing any normal, day-to-day activities. Return to work time varies depending on your occupation, but the average is 12 days.