Patterns of reoperation after failed fundoplication: an analysis of 9462 patients.

BACKGROUND: Little is known about the choice of reoperation after failed fundoplication for gastroesophageal reflux disease. Both redo fundoplication and conversion procedure to Roux-en-Y gastric bypass (RYGB) are safe and effective. We aimed to characterize the rates of different revisional procedures and to identify risk factors associated with failed fundoplication.

METHODS: Using a statewide database, we examined records for patients who underwent fundoplication between 2000 and 2010. The primary outcomes were the rate of each type of reoperation and the pattern of subsequent procedures. Demographics and comorbidities were used in a multivariable logistic regression model to identify risk factors associated with reoperation after fundoplication.

RESULTS: A total of 9462 patients were included. Overall, 430 (4.5%) patients underwent reoperation. Of those, 46 (10.7%) patients underwent RYGB at first reoperation, with the remainder having a redo fundoplication. An additional five patients were converted to RYGB after undergoing a redo fundoplication (51 total patients converted to RYGB at any point, 11.9%). Eighty-three percent of patients converted to RYGB were obese, as opposed to 8% for redo fundoplication. A single redo fundoplication was done in 81% of patients, while 35 patients (8.1%) underwent two or more revisional procedures. On average, any reoperation was performed 2.9 years after fundoplication, with redo fundoplication 2.5 years and RYGB 6.5 years later. Age 30-49 years (vs. >70 years; OR 2.01, p = 0.011) and 50-69 years (vs. >70 years; OR 1.61, p = 0.011), female gender (OR 1.56, p = < 0.0001), and chronic pulmonary disease (OR 1.40, p = 0.0044) were associated with revisional surgery.

CONCLUSIONS: Fundoplication has a low reoperation rate within a mean 8.3 years of follow-up. Redo fundoplication is more commonly performed and at an earlier point than conversion to RYGB. Younger age, female gender, and chronic pulmonary disease are associated with reoperation after fundoplication.