Reoperation for failed reflux surgery.

Common causes of failure for gastroesophageal reflux surgery, whether associated with hiatal hernia (HH) or not, include a too tight closure of the crurae, a too tight fundoplication, recurrent HH, total or partial disruption of the wrap and a slipped fundoplication in the chest or down onto the stomach. A laparoscopic approach to patients with failure or complication after antireflux surgery now represents the standard of care after a laparoscopic procedure. The transthoracic approach may be of added value after one or two reoperations, and remains a firm option in more complicated patients.