Retrospective Study
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World J Gastroenterol. Dec 7, 2014; 20(45): 17115-17119
Published online Dec 7, 2014. doi: 10.3748/wjg.v20.i45.17115
Revision of failed transoral incisionless fundoplication by subsequent laparoscopic Nissen fundoplication
Awais Ashfaq, Hyun K Rhee, Kristi L Harold
Awais Ashfaq, Kristi L Harold, Hyun K (Daniel) Rhee, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, United States
Author contributions: Ashfaq A and Harold KL designed the study and involved in following patients; Ashfaq A and Rhee HK were involved in data entry, data reporting; Ashfaq A and Rhee HK did the literature review; Ashfaq A, Rhee HK and Harold KL formulated the first draft of the paper and critically reviewed it for final processing; all authors read and agreed the final version of the manuscript.
Correspondence to: Kristi L Harold, MD, FACS, Chair, Associate Professor of Surgery, Department of Surgery, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, United States. ashfaq.awais@mayo.edu
Telephone: +1-480-3422849 Fax: +1-480-3423467
Received: November 29, 2013
Revised: March 19, 2014
Accepted: May 29, 2014
Published online: December 7, 2014
Processing time: 376 Days and 13.5 Hours
Abstract

AIM: To evaluate the feasibility and outcomes of laparoscopic Nissen fundoplication after failed transoral incisionless fundoplication (TIF).

METHODS: TIF is a new endoscopic approach for treating gastroesophageal reflux disease (GERD). In cases of TIF failure, subsequent laparoscopic fundoplication may be required. All patients from 2010 to 2013 who had persistence and objective evidence of recurrent GERD after TIF underwent laparoscopic Nissen fundoplication. Primary outcome measures included operative time, blood loss, length of hospital stay and complications encountered.

RESULTS: A total of 5 patients underwent revisional laparoscopic Nissen fundoplication (LNF) or gastrojejunostomy for recurrent GERD at a median interval of 24 mo (range: 16-34 mo) after TIF. Patients had recurrent reflux symptoms at an average of 1 mo following TIF (range: 1-9 mo). Average operative time for revisional surgical intervention was 127 min (range: 65-240 min) and all surgeries were performed with a minimal blood loss (< 50 mL). There were no cases of gastric or esophageal perforation. Three patients had additional finding of a significant hiatal hernia that was fixed simultaneously. Median length of hospitalization was 2 d (range: 1-3 d). All patients had resolution of symptoms at the last follow up.

CONCLUSION: LNF is a feasible and safe option in a patient who has persistent GERD after a TIF. Previous TIF did not result in additional operative morbidity.

Keywords: Transoral incisionless fundoplication; Laparascopic Nissen fundoplication; Laparoscopy; Gastroesophageal reflux disease; Surgical complications

Core tip: Even though transoral incisionless fundoplication (TIF) has been shown to be less invasive and has the hope of decreasing the symptoms of reflux. Laparoscopic Nissen still remains the gold standard. The paper highlights that some people can have persistent gastroesophageal reflux disease even after TIF and in these cases a Nissen, even though, technically challenging is feasible without any complications in experienced hands. We believe it fills the gap for a community based general surgeon to know how to take care of such patients as the number of such patients would continue to increase as more and more TIF is employed.