Quality of life and long-term results of reinterventions performed by laparoscopy after oesophageal hiatus surgery

Introduction: Laparoscopic surgery has had a significant impact on gastro-oesophageal reflux disease (GORD), para-oesophageal hiatal hernia (POHH) and achalasia. There have been a percentage of poor results due to reappearance, persistence or appearance of new symptoms. Reinterventions of the hiatus are more complicated and are not always accompanied by a satisfactory clinical response. Objective: To evaluate the long-term results of a series of 20 patients reintervened by laparoscopy and their quality of life. Material and methods: A total of 20 patients operated on between February 1998 and December 2008 after previous surgery for the hiatus. The mean age of the patients was 56 (19-77) years. A total of 18 patients had been operated on due to GORD or POHH and 2 due to achalasia. They were followed up until December 2008 and a quality of life GIQLI test was performed. Results: Of the 20 patients, 13 were operated on by laparoscopy and 7 by laparotomy. The mean pre-operative time was 74 (1-24) months. The reintervention was for GORD and HH in 12 (63%); dysphagia in 4 (21%) and POHH (3). Conversion was 10% and the operating time was 180 (105-300) min. The procedures were: pillar closure and re-Nissen (10), re-Nissen (2), Toupet (2), Collis (1), mesh removal (1), re-myotomy (2), and pexy (1). There was 16% morbidity and no mortality. After a follow up of 68 (1-116) months, 14 patients were symptom-free. The GIQLI score was 106 (97-124), which was less than standard (125). Conclusions: Reintervention of hiatus is reliable and effective over the long-term, but quality of life scores were lower than normal. © 2009 AEC.