Laparoscopic antireflux surgery after failed endoscopic treatments for gastroesophageal reflux disease.

Objective: The aim of this study is to assess the efficacy and safety of laparoscopic antireflux surgery (LARS) after failed endoscopic treatments for gastroesophageal reflux disease.

Materials And Methods: The perioperative results of 9 patients, who had received endoscopic antireflux intervention before being subjected to LARS between March 2004 and November 2009, were analyzed retrospectively on a prospective database.

Results: Endoscopically, while 6 patients had received radiofrequency ablation (Stretta; Curon Medical, Fremont, CA), 2 patients had been subjected to biopolymer injection (Enteryx; Boston Scientific, Natick, MA) and 1 patient to endoluminal plication (NDO plicator; NDO Surgical, Mansfield, MA). The mean age of the patients was 40 years while the mean values for their body mass index, symptom duration, and follow-up length were 25.6, 38 months, and 35 months, respectively. Mean operation length and mean discharge time were 56 minutes and 1 day, respectively. None of the patients who were subjected to NDO plicator and Stretta showed difficulty in dissection or perioperative complication. In contrast, the patients who had been subjected to Enteryx presented serious problems during LARS, and because of severe difficulty in dissection total fundoplication could not be performed. In both of those cases, LARS did not succeed.

Conclusions: In patients who received Stretta and NDO plicator procedures and failed to respond, LARS does not present any difficulty or problem. However, performing LARS among patients who received Enteryx shows problems and fails to produce a successful result.