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Surgical reintervention after failed antireflux surgery: a systematic review of the literature.

Furnée EJ, Draaisma WA, Broeders IA, Gooszen HG - J. Gastrointest. Surg. (2009)

Bottom Line: Symptomatic outcome was successful in 81.1% and was equal in the laparoscopic and conventional approach.Objective outcome was obtained in 24 studies (29.6%) and success was reported in 78.3%, with a slightly higher success rate in case of laparoscopy than with open surgery (85.8% vs. 78.0%).Data on objective results were scarce and consistency with regard to reporting outcome is necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, H.P. G04.228, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.

ABSTRACT

Background: Outcome and morbidity of redo antireflux surgery are suggested to be less satisfactory than those of primary surgery. Studies reporting on redo surgery, however, are usually much smaller than those of primary surgery. The aim of this study was to summarize the currently available literature on redo antireflux surgery.

Material and methods: A structured literature search was performed in the electronic databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials.

Results: A total of 81 studies met the inclusion criteria. The study design was prospective in 29, retrospective in 15, and not reported in 37 studies. In these studies, 4,584 reoperations in 4,509 patients are reported. Recurrent reflux and dysphagia were the most frequent indications; intraoperative complications occurred in 21.4% and postoperative complications in 15.6%, with an overall mortality rate of 0.9%. The conversion rate in laparoscopic surgery was 8.7%. Mean(+/-SEM) duration of surgery was 177.4 +/- 10.3 min and mean hospital stay was 5.5 +/- 0.5 days. Symptomatic outcome was successful in 81.1% and was equal in the laparoscopic and conventional approach. Objective outcome was obtained in 24 studies (29.6%) and success was reported in 78.3%, with a slightly higher success rate in case of laparoscopy than with open surgery (85.8% vs. 78.0%).

Conclusion: This systematic review on redo antireflux surgery has confirmed that morbidity and mortality after redo surgery is higher than after primary surgery and symptomatic and objective outcome are less satisfactory. Data on objective results were scarce and consistency with regard to reporting outcome is necessary.

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Related in: MedlinePlus

Results of search strategy and selection of studies.
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Fig1: Results of search strategy and selection of studies.

Mentions: One thousand six hundred twenty-five articles were eligible for further selection after removing duplicate hits, and finally, 73 articles met the inclusion criteria (Fig. 1). The references of these articles yielded eight more articles for inclusion. These articles had not been identified with the initial search strategy because of absence of abstracts in the databases or atypical description for the intervention or disease. Eventually, 81 articles were eligible for inclusion in this study. According to the Oxford Centre for Evidence Based Medicine Levels of Evidence, 27 studies had a level of evidence IIb (33.3%)8, 10–35, two level of evidence IIIb (2.5%)36, 37, and 15 level of evidence IV (18.5%)38–52. The remaining 37 studies (45.7%) were cohort studies, but a level of evidence could not be adjudged owing to unknown study design53–89. Baseline characteristics extracted from the individual studies are shown in Table 2.Figure 1


Surgical reintervention after failed antireflux surgery: a systematic review of the literature.

Furnée EJ, Draaisma WA, Broeders IA, Gooszen HG - J. Gastrointest. Surg. (2009)

Results of search strategy and selection of studies.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2710493&req=5

Fig1: Results of search strategy and selection of studies.
Mentions: One thousand six hundred twenty-five articles were eligible for further selection after removing duplicate hits, and finally, 73 articles met the inclusion criteria (Fig. 1). The references of these articles yielded eight more articles for inclusion. These articles had not been identified with the initial search strategy because of absence of abstracts in the databases or atypical description for the intervention or disease. Eventually, 81 articles were eligible for inclusion in this study. According to the Oxford Centre for Evidence Based Medicine Levels of Evidence, 27 studies had a level of evidence IIb (33.3%)8, 10–35, two level of evidence IIIb (2.5%)36, 37, and 15 level of evidence IV (18.5%)38–52. The remaining 37 studies (45.7%) were cohort studies, but a level of evidence could not be adjudged owing to unknown study design53–89. Baseline characteristics extracted from the individual studies are shown in Table 2.Figure 1

Bottom Line: Symptomatic outcome was successful in 81.1% and was equal in the laparoscopic and conventional approach.Objective outcome was obtained in 24 studies (29.6%) and success was reported in 78.3%, with a slightly higher success rate in case of laparoscopy than with open surgery (85.8% vs. 78.0%).Data on objective results were scarce and consistency with regard to reporting outcome is necessary.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, H.P. G04.228, University Medical Centre Utrecht, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.

ABSTRACT

Background: Outcome and morbidity of redo antireflux surgery are suggested to be less satisfactory than those of primary surgery. Studies reporting on redo surgery, however, are usually much smaller than those of primary surgery. The aim of this study was to summarize the currently available literature on redo antireflux surgery.

Material and methods: A structured literature search was performed in the electronic databases of MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials.

Results: A total of 81 studies met the inclusion criteria. The study design was prospective in 29, retrospective in 15, and not reported in 37 studies. In these studies, 4,584 reoperations in 4,509 patients are reported. Recurrent reflux and dysphagia were the most frequent indications; intraoperative complications occurred in 21.4% and postoperative complications in 15.6%, with an overall mortality rate of 0.9%. The conversion rate in laparoscopic surgery was 8.7%. Mean(+/-SEM) duration of surgery was 177.4 +/- 10.3 min and mean hospital stay was 5.5 +/- 0.5 days. Symptomatic outcome was successful in 81.1% and was equal in the laparoscopic and conventional approach. Objective outcome was obtained in 24 studies (29.6%) and success was reported in 78.3%, with a slightly higher success rate in case of laparoscopy than with open surgery (85.8% vs. 78.0%).

Conclusion: This systematic review on redo antireflux surgery has confirmed that morbidity and mortality after redo surgery is higher than after primary surgery and symptomatic and objective outcome are less satisfactory. Data on objective results were scarce and consistency with regard to reporting outcome is necessary.

Show MeSH
Related in: MedlinePlus