Personalizes approach to selecting revision antireflux surger
https://doi.org/10.17238/2072-3180-2025-3-220-227
Abstract
Introduction. Recurrences of hiatal hernias and gastroesophageal reflux disease (GERD) following primary surgical treatment remain a challenging problem in abdominal surgery. Failure rates reach 15–60 %, with key manifestations including recurrent reflux, dysphagia, and gas–bloat syndrome. The causes of recurrence are multifactorial: fundoplication wrap migration, cicatricial strictures, diaphragmatic weakness, and technical errors from the initial procedure.
The purpose of the study. To analyze existing fundoplication techniques and develop personalized approaches to reoperative antireflux surgery. This strategy is based on comprehensive preoperative diagnostics, analysis of primary surgery failure causes, and selection of optimal corrective methods (fundoplication type, mesh reinforcement necessity, esophageal mobilization).
Materials and methods of research. Review of articles published in scientific databases such as PubMed, Web of Science, Scopus, and eLIBRARY.
Results of research. Performing comprehensive multimodal diagnostics enables identification of the causes of recurrent hiatal hernia and GERD. For large defects, the use of a U–shaped synthetic mesh is justified. For esophageal shortening less than 1 cm, Collis gastroplasty is indicated; for shortening exceeding 1–2 cm, Chernousov's technique is applied. A complete fundoplication is applicable in cases of severe reflux with normal motility, a partial fundoplication is used for significant dysphagia and hypomotility, and an anterior fundoplication is indicated in the presence of cicatricial fibrosis or as an adjunct to cardiomyotomy for achalasia.
Conclusion. Revisional surgery requires strictly individualized management. Success depends on: precise diagnostics, appropriate technique selection (combined cruroplasty, mesh repair, fundoplication), anatomical defect correction, surgical expertise, and adherence to rehabilitation protocols – minimizing recurrences in complex cases.
About the Authors
T. Zhang
Department of General Surgery of the First Moscow State Medical University. THEM. Sechenov
Russian Federation
Russian Federation
Zhang Tong – Postgraduate student
119992, Trubetskaya str., 8/2, Moscow
Y. Cai
Department of General Surgery of the First Moscow State Medical University. THEM. Sechenov
Russian Federation
Russian Federation
Cai Yuqing – Postgraduate student
119992, Trubetskaya str., 8/2, Moscow
E. A. Gallyamov
Department of General Surgery of the First Moscow State Medical University. THEM. Sechenov
Russian Federation
Russian Federation
Gallyamov Eduard Abdulkhaevich – Doctor of Medical Sciences, Professor, Head of the Department
119992, Trubetskaya str., 8/2, Moscow
A. R. Sadykov
Department of Surgery of the Russian University of Medicine of the Ministry of Health of the Russian Federation
Russian Federation
Russian Federation
Sadykov Airat Rashidovich – Student
127006, Dolgorukovskaya str., 4, Moscow
References
1. Hashemi M., Peters J.H., DeMeester T.R., Huprich J.E., Quek M., Hagen J.A., Crookes P.F., Theisen J., DeMeester S.R., Sillin L.F., Bremner C.G. Laparoscopic repair of large type III hiatal hernia: objective followup reveals high recurrence rate. J Am Coll Surg, 2000, № 190 (5), pp. 553–560. https://doi.org/10.1016/s1072–7515(00)00260–x
2. Stylopoulos N., Gazelle G.S., Rattner D.W. Paraesophageal hernias: operation or observation? Ann Surg, 2002, № 236 (4), pp. 492–500. https://doi.org/10.1097/00000658–200210000–00012
3. Dallemagne B., Arenas Sanchez M., Francart D., Perretta S., Weerts J., Markiewicz S., Jehaes C. Long–term results after laparoscopic reoperation for failed antireflux procedures. Br J Surg, 2011, № 98 (11), pp. 1581–1587. https://doi.org/10.1002/bjs.7590
4. Lord R.V., Kaminski A., Oberg S., Bowrey D.J., Hagen J.A., DeMeester S.R., Sillin L.F., Peters J.H., Crookes P.F., DeMeester T.R. Absence of gastroesophageal reflux disease in a majority of patients taking acid suppression medications after Nissen fundoplication. J Gastrointest Surg, 2002, № 6 (1), pp. 3–9. https://doi.org/10.1016/s1091–255x(01)00031–2
5. Awais O., Luketich J.D., Schuchert M.J., Morse C.R., Wilson J., Gooding W.E., Landreneau R.J., Pennathur A. Reoperative antireflux surgery for failed fundoplication: an analysis of outcomes in 275 patients. Ann Thorac Surg, 2011, № 92 (3), pp. 1083–1089. https://doi.org/10.1016/j.athoracsur.2011.02.088
6. Fedorov V.I., Burmistrov M.V., Sharapov T.L., et al. Analysis of reconstructive interventions in case of failures in hiatal hernia surgery. Grekov's Bulletin of Surgery, 2024, № 183 (3), pp. 38–43. (In Russ.) https://doi.org/10.24884/0042–4625–2024–183–3–38–43
7. Horgan S., Pohl D., Bogetti D., Eubanks T., Pellegrini C. Failed antireflux surgery: what have we learned from reoperations? Arch Surg, 1999, № 134 (8), pp. 809–815. https://doi.org/10.1001/archsurg.134.8.809
8. Baker M.E. Role of the Barium Esophagram in Antireflux Surgery. Gastroenterol Hepatol (N Y), 2014, № 10 (10), pp. 677–679.
9. Patti M.G., Robinson T., Galvani C., Gorodner M.V., Fisichella P.M., Way L.W. Total fundoplication is superior to partial fundoplication even when esophageal peristalsis is weak. J Am Coll Surg, 2004, № 198 (6), pp. 863–869. https://doi.org/10.1016/j.jamcollsurg.2004.01.029
10. Slater B.J., Dirks R.C., McKinley S.K., Ansari M.T., Kohn G.P., Thosani N., Qumseya B., Billmeier S., Daly S., Crawford C., Ehlers A.P., Hollands C., Palazzo F., Rodriguez N., Train A., Wassenaar E., Walsh D., Pryor A.D., Stefanidis D. SAGES guidelines for the surgical treatment of gastroesophageal reflux (GERD). Surg Endosc, 2021, № 35 (9), pp. 4903–4917. https://doi.org/10.1007/s00464–021–08625–5
11. Mainie I., Tutuian R., Shay S., Vela M., Zhang X., Sifrim D., Castell D.O. Acid and non–acid reflux in patients with persistent symptoms despite acid suppressive therapy: a multicentre study using combined ambulatory impedance–pH monitoring. Gut, 2006, № 55 (10), pp. 1398–1402. https://doi.org/10.1136/gut.2005.087668
12. Granderath F.A., Carlson M.A., Champion J.K., Szold A., Basso N., Pointner R., Frantzides C.T. Prosthetic closure of the esophageal hiatus in large hiatal hernia repair and laparoscopic antireflux surgery. Surg Endosc, 2006, № 20 (3), pp. 367–379. https://doi.org/10.1007/s00464–005–0467–0
13. Varela J.E., Hinojosa M.W., Nguyen N.T. Laparoscopic fundoplication compared with laparoscopic gastric bypass in morbidly obese patients with gastroesophageal reflux disease. Surg Obes Relat Dis, 2009, № 5 (2), pp. 139–143. https://doi.org/10.1016/j.soard.2008.08.021
14. Luketich J.D., Nason K.S., Christie N.A., Pennathur A., Jobe B.A., Landreneau R.J., Schuchert M.J. Outcomes after a decade of laparoscopic giant paraesophageal hernia repair. J Thorac Cardiovasc Surg, 2010, № 139 (2), pp. 395–404. https://doi.org/10.1016/j.jtcvs.2009.10.005
15. Granderath F.A., Schweiger U.M., Kamolz T., Asche K.U., Pointner R. Laparoscopic Nissen fundoplication with prosthetic hiatal closure reduces postoperative intrathoracic wrap herniation: preliminary results of a prospective randomized functional and clinical study. Arch Surg, 2005, № 140 (1), pp. 40–48. https://doi.org/10.1001/archsurg.140.1.40
16. Stadlhuber R.J., Sherif A.E., Mittal S.K., Fitzgibbons R.J. Jr., Michael Brunt L., Hunter J.G., Demeester T.R., Swanstrom L.L., Daniel Smith C., Filipi C.J. Mesh complications after prosthetic reinforcement of hiatal closure: a 28–case series. Surg Endosc, 2009, № 23 (6), pp. 1219–1226. https://doi.org/10.1007/s00464–008–0205–5
17. Müller–Stich B.P., Kenngott H.G., Gondan M., Stock C., Linke G.R., Fritz F., Nickel F., Diener M.K., Gutt C.N., Wente M., Büchler M.W., Fischer L. Use of mesh in laparoscopic paraesophageal hernia repair: a meta– analysis and risk–benefit analysis. PLoS One, 2015, № 10 (10). https://doi.org/10.1371/journal.pone.0139547
18. Grubnik V.V., Malynovskyy A.V. Laparoscopic repair of hiatal hernias: new classification supported by long–term results. Surg Endosc, 2013, № 27 (10), pp. 4337–4346. https://doi.org/10.1007/s00464–013–3069–2
19. Frantzides C.T., Madan A.K., Carlson M.A., Stavropoulos G.P. A prospective, randomized trial of laparoscopic polytetrafluoroethylene (PTFE) patch repair vs simple cruroplasty for large hiatal hernia. Arch Surg, 2002, № 137 (6), pp. 649–652. https://doi.org/10.1001/archsurg.137.6.649
20. Oor J.E., Roks D.J., Koetje J.H., Broeders J.A., van Westreenen H.L., Nieuwenhuijs V.B., Hazebroek E.J. Randomized clinical trial comparing laparoscopic hiatal hernia repair using sutures versus sutures reinforced with non–absorbable mesh. Surg Endosc, 2018, № 32 (11), pp. 4579–4589. https://doi.org/10.1007/s00464–018–6211–3
21. Yano F., Stadlhuber R.J., Tsuboi K., Garg N., Filipi C.J., Mittal S.K. Preoperative predictability of the short esophagus: endoscopic criteria. Surg Endosc, 2009, № 23 (6), pp. 1308–1312. https://doi.org/10.1007/s00464–008–0155–y
22. Johnson A.B., Oddsdottir M., Hunter J.G. Laparoscopic Collis gastroplasty and Nissen fundoplication. A new technique for the management of esophageal foreshortening. Surg Endosc, 1998, № 12 (8), pp. 1055–10. https://doi.org/10.1007/s004649900780
23. Chernousov A.F., Bogopolskiy P.M., Kurbanov F.S. Khirurgiya pishchevoda. M. : Meditsina, 2000. 349 p. (In Russ.)
24. Swanstrom L.L., Marcus D.R., Galloway G.Q. Laparoscopic Collis gastroplasty is the treatment of choice for the shortened esophagus. Am J Surg, 1996, № 171 (5), pp. 477–481. https://doi.org/10.1016/S0002–9610(96)00008–6
25. Swanstrom L.L., Jobe B.A., Kinzie L.R., Horvath K.D. Esophageal motility and outcomes following laparoscopic paraesophageal hernia repair and fundoplication. Am J Surg, 1999, № 177 (5), pp. 359–563.https://doi.org/10.1016/s0002–9610(99)00062–8
26. Carlson M.A., Richards C.G., Frantzides C.T. Laparoscopic prosthetic reinforcement of hiatal herniorrhaphy. Dig Surg, 1999, № 16 (5), pp. 407–410. https://doi.org/10.1159/000018756
27. Fein M., Seyfried F. Is there a role for anything other than a Nissen's operation? J Gastrointest Surg, 2010, № 14 (1), pp. 67–74. https://doi.org/10.1007/s11605–009–1020–6
28. Booth M.I., Stratford J., Jones L., Dehn T.C. Randomized clinical trial of laparoscopic total (Nissen) versus posterior partial (Toupet) fundoplication for gastro-oesophageal reflux disease based on preoperative oesophageal manometry. Br J Surg, 2008, № 95 (1), pp. 57–63. https://doi.org/10.1002/bjs.6047
29. Lundell L., Abrahamsson H., Ruth M., Rydberg L., Lönroth H., Olbe L. Long–term results of a prospective randomized comparison of total fundic wrap (Nissen–Rossetti) or semifundoplication (Toupet) for gastro–oesophageal reflux. Br J Surg, 1996, № 83 (6), pp. 830–835. https://doi.org/10.1002/bjs.1800830633
30. Hagedorn C., Jönson C., Lönroth H., Ruth M., Thune A., Lundell L. Efficacy of an anterior as compared with a posterior laparoscopic partial fundoplication: results of a randomized, controlled clinical trial. Ann Surg, 2003, № 238 (2), pp. 189–196. https://doi.org/10.1097/01.sla.0000080821
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For citations:
Zhang T., Cai Y., Gallyamov E.A., Sadykov A.R. Personalizes approach to selecting revision antireflux surger. Moscow Surgical Journal. 2025;(3):220-227. (In Russ.) https://doi.org/10.17238/2072-3180-2025-3-220-227
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