A prospective comparison of outcomes in a case-matched population of primary vs. revisional laparoscopic fundoplication

Aims Patient centred outcomes from primary (P) laparoscopic fundoplication (LF) are acceptable in the short-medium term. Less is known regarding revisional (R) surgery. In a single-operator series, we compare outcomes across a matched patient cohort to ascertain efficacy, and to identify markers of potential operative or patient-related problems.Methods Case-matched patients, including all R, were retrieved from a prospective database based on time-since surgery and sex. Operative details/subsequent investigations were collated and REFLUX questionnaires completed by telephone. Outcome measures were REFLUX quality-of-life score (RQS) and subscores, return to proton pump inhibitor (PPI)use, andobjective evidence of recurrence (OR). Data were analysed using SPSSv19.Results 75% of 110 patients responded (43,78%P:40,73%R). Sex (40%male,P&R), mean age(51:53 years), and mean time since surgery were equivalent(6.0:5.9 years). Median RQS, and symptom-subscores were equivalent (NS, Mann-Whitney U). 5(9%)P:8(15%)R had OR(NS, v2); further 29 patients across groups took PPI without OR. No technical aspect of surgery(direction, degree of wrap, nor reinforcement) was associated with RQS (NS, Mann Whitney U), nor PPI use/OR(NS, v2).Conclusion Outcome determination following LF is difficult and the importance of patient-centred measures increasingly recognised. This case-series illustrates equivalence between revisional and primary surgery—although recurrence itself may be a marker of further recurrence risk. These data support the option of revisional surgery, but emphasise need for carefulcounselling regarding outcomes.Key statement The outcome of revisional laparoscopic surgery, following recurrence of reflux after fundoplication, is not well described. Comparison between two case matched groups of patients undergoing primary and revisional laparoscopic fundoplication indicated equivalence postoperatively, including quality-of-life measures, although recurrence may increase the risk of further recurrence.