Re-operative antireflux surgery requires extensive pre-operative evaluation to determine the cause of failure and appropriate surgical approach. Common causes of failure include inadequate crus closure, fundoplication disruption, and esophageal shortening. The surgical approach should be tailored to the suspected mechanism of failure but often involves dismantling prior operations andredoing the fundoplication. Re-operation has a higher failure rate than initial surgery due to surgical challenges and patient factors.

1. Complications Following Antireflux Surgery: Recognition and Management George Ferzli, MD, FACS

3. Intra-operative complications Pleura / lung breech during hiatal dissection

13. Predictability of mechanism of failure Iqbal et al. 104 failed anti-reflux procedures Iqbal et al. Reoperation for Failed Anti-Reflux Surgery. Ann Surg 2006; 244: 42-51. Mechanism of failure % of pre-operative predictability Crus closure failure 96 Hiatal stenosis 20 Partial fundoplication disruption 86 Complete fundoplication disruption 86 Hypertensive fundoplication 92 Slipped fundoplication 89 Loose fundoplication 50 Short esophagus 37 Gastroparesis 100