New trends at the causes of recurrence of gastroesophageal reflux disease and hiatal hernia: failed fundoplication

Introduction. For a long time, progression of the underlying disease was considered the main reason for the development of recurrence (in particular, due to the reasons described above). However, to date, the results of numerous comparative studies demonstrate that in some cases the development of clinical and radiological relapse of the disease is due precisely to non-compliance with the technical aspects of the primary antireflux intervention.

Purpose of the work: to assess the causes of recurrence of hiatal hernia and GERD in a group of patients, to determine the key aspects leading to relapse, and to introduce the term “failed fundoplication.”

Materials and methods. The study evaluated 56 patients who underwent laparoscopic revision fundoplication. In all patients, the following parameters were assessed: absence of isolation of the abdominal part of the esophagus, absence of cruroplasty, absence of an antireflux mechanism (signs of the use of absorbable suture material), compression of the esophagus (by a mesh implant or hyperfunction of the cuff), the presence of an “old” hernial sac (which was not removed in previous operation), lack of fixation of the fundoplication cuff to the esophagus, injury n.vagus, technically incorrectly formed fundoplication cuff.

Results. In all patients, technical errors of the primary intervention were identified which, was a recurrence of GERD and hiatal hernia.

Conclusion. Fulfillment of the proposed technical errors are predictors of programmed recurrence of hiatal hernia and GERD. Intraoperative identification of these errors suggests that the primary antireflux intervention was a “failure.”

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