REPEATED LAPAROSCOPIC ANTIREFLUX SURGERY IN PATIENTS WITH HIATAL HERNIA

Objectives. Laparoscopic fundoplication is considered the “gold standard” for definitive treatment of gastroesophageal reflux disease. In 85-96% of patients, good short-term and long-term results are noted, andб in 5-8% of patients, it becomes necessary to perform repeated laparoscopic antireflux operations. The purpose was to study the features and results of redo laparoscopic antireflux surgery in our clinic.

Materials and methods. For the period from 2008 to 2020 laparoscopic antireflux operations were performed in 1274 patients. 62 patients underwent laparoscopic reoperation during the study period based on the following indications: recurrence of hiatal hernia (n=37), gastric stasis (n=3) recurrent reflux (n=8), dysphagia (n=8), severe pain (n=6). All patients underwent repeated examinations in our clinic, telephone interviews, mailing of special questionnaires. All complaints were recorded, the quality of life was determined according to the GERD-HRQL questionnaire.

Results. All redo operations were performed laparoscopically without conversion to laparotomy. Intraoperative complications were observed in 11.11% of patients. Long-term follow up from 6 months to 6 years was observed in 90.74% of patients. The quality of life of patients according to the GERD-HRQL questionnaire significantly improved in long-term follow-up (p<0.001). Good and excellent results were observed in 90,3% of patients after redo operations. The third operation was needed in 8.06% of patients.

Conclusion. Redo laparoscopic antireflux operations are technically difficult surgical interventions, and should be performed by surgeons with big experience in the antireflux surgery. Laparoscopic antireflux surgery provide good long-term results in 90% of patients.