Surgical management of the failed Nissen fundoplication.

A significant percentage of surgery performed for complications of gastroesophageal reflux at a major medical center has been performed for problems related to prior surgery. Our patients who required remedial surgery fell into three categories. Those with recurrent reflux generally fared well. Patients with dysphagia, gastric stasis, or both presented difficult problems. The key to success for these patients lies in choosing the operation best suited to the anatomic and physiologic situation as defined by preoperative contrast studies, pH monitoring, endoscopy, and selective gastric emptying studies.