Background: With the increasing number of laparoscopic fundoplications, many more
patients with a failed primary antireflux operation are being referred for
complex redo procedures. The objective of this study was to evaluate our
results of redo antireflux surgery using the Belsey Mark IV (BMIV) Repair. Methods: A retrospective analysis of the patients who underwent BMIV repair following a
failed fundoplication was performed. The primary endpoint was failure of the
redo procedure and recurrent hiatal hernia. Secondary endpoints were assessment
of the functional results of the redo fundoplication and quality of life with a
Dysphagia Score, and Gastroesophageal Reflux Disease-Health-Related Quality of
Life (GERD-HRQOL) questionnaire. Results: 206 patients underwent surgery
for failed primary fundoplication. Most patients had one prior antireflux
surgery 148/206 (71.8%). The most common primary failed fundoplication was the
Nissen procedure (189/206, 91.7%). The median time from the prior operation to
the redo operation was 34 months. Median follow-up was 25.6 months. The
Dysphagia score decreased from 3.6 ± 0.5 preoperatively to 1.0 ± 0.4
postoperatively (p < 0.0001). At the time of follow-up, the Median GERD-HRQL
score was 4 (range 0 - 9), classified as excellent, compared to a preoperative
Median GERD-HRQL score of 43 (range 41 - 50) which was classified as poor. (p <
0.0001). There was no recurrence of the hiatal hernia. Conclusion: Complete takedown and reestablishment of the normal anatomy, recognition of a
short esophagus, and proper placement of the wrap are essential components of a
redo antireflux procedure. The BMIV repair as the choice of reopertaive procedure
results in excellent symptom relief, significant improvement in quality of
life, and is associated with excellent medium-term durability in terms of
recurrence of the hiatal hernia.
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