Celasin Haydar, Genc Volkan, Celik Suleyman Utku, Turkcapar Ahmet Gökhan
Kavaklidere Umut Private Hospital Ankara University School of Medicine, Department of General Surgery, Ankara, Turkey.
Medicine (Baltimore). 2017 Jan;96(1):e5779. doi: 10.1097/MD.0000000000005779.
Laparoscopic antireflux surgery is a frequently performed procedure for the treatment of gastroesophageal reflux in surgical clinics. Reflux can recur in between 3% and 30% of patients on whom antireflux surgery has been performed, and so revision surgery can be required due to recurrent symptoms or dysphagia in approximately 3% to 6% of the patients. The objective of this study is to evaluate the mechanism of recurrences after antireflux surgery and to share our results after revision surgery in recurrent cases.From 2001 to 2014, revision surgery was performed on 43 patients (31 men, 12 women) between the ages of 24 and 70 years. The technical details of the first operation, recurrence symptoms, endoscopy, and manometry findings were evaluated. The findings of revision surgery, surgical techniques, morbidity rates, length of hospitalization, and follow-up period were also recorded and evaluated.The first operation was Nissen fundoplication in 34 patients and Toupet fundoplication in 9 patients. Mesh hiatoplasty was performed for enforcement in 18 (41.9%) of these patients. The period between the first operation and the revision surgery ranged from 4 days to 60 months. The most common finding was slipped fundoplication and presence of hiatal hernia during revision surgery. Revision fundoplication and hernia repair with mesh reinforcement were used in 33 patients. The other techniques were Collis gastroplasty, revision fundoplication, and hernia repair without mesh. The range of follow-up period was from 2 to 134 months. Recurrence occurred in 3 patients after revision surgery (6.9%). Although revision surgery is difficult and it has higher morbidity, it can be performed effectively and safely in experienced centers.
腹腔镜抗反流手术是外科诊所中治疗胃食管反流的常用手术。接受抗反流手术的患者中，3%至30%可能会出现反流复发，因此约3%至6%的患者因症状复发或吞咽困难可能需要进行翻修手术。本研究的目的是评估抗反流手术后复发的机制，并分享我们对复发病例进行翻修手术后的结果。
2001年至2014年，对43例年龄在24岁至70岁之间的患者（31例男性，12例女性）进行了翻修手术。评估了首次手术的技术细节、复发症状、内镜检查和测压结果。还记录并评估了翻修手术的结果、手术技术、发病率、住院时间和随访期。
首次手术中，34例患者进行了nissen胃底折叠术，9例患者进行了Toupet胃底折叠术。其中18例（41.9%）患者进行了网状裂孔成形术以加强。首次手术至翻修手术的时间间隔为4天至60个月。最常见的发现是翻修手术期间胃底折叠术滑脱和存在食管裂孔疝。33例患者采用了翻修胃底折叠术和网状加强疝修补术。其他技术包括Collis胃成形术、翻修胃底折叠术和无网状物的疝修补术。随访期为2至134个月。翻修手术后3例患者复发（6.9%）。虽然翻修手术难度大且发病率较高，但在经验丰富的中心可以有效且安全地进行。
