Revisional Laparoscopic Antireflux Surgery After Transoral Incisionless Fundoplication

<p>Transoral incisionless fundoplication (TIF) is increasingly accepted as an effective management strategy for refractory gastroesophageal reflux, especially in patients with minimal or no hiatal hernia. All antireflux procedures have a failure rate, however, and TIF is no exception. Nevertheless, it has significant advantages and likely will continue to gain widespread adoption.</p><p>One concern about the procedure that is commonly expressed is the potential for a challenging dissection at the hiatus during reoperative surgery. The authors’ program includes TIF as a treatment option, and one of their earliest patients required conversion to a laparoscopic fundoplication. This video demonstrates the expected anatomy during reoperation. It is helpful to consider the transoral procedure as having much in common with a Belsey fundoplication; much of the adhesion encountered during dissection will be at the left crus. Conversion to a conventional fundoplication when indicated is effective, safe, and should not preclude a more widespread adoption of the TIF procedure.</p> <p><b>Suggested Reading</b></p> <p>Testoni PA, Testoni S, Mazzoleni G, Vailati C, Passaretti S. Long-term efficacy of transoral incisionless fundoplication with Esophyx (Tif 2.0) and factors affecting outcomes in GERD patients followed for up to 6 years: a prospective single-center study. <i><a href="https://doi.org/10.1007/s00464-014-4008-6">Surg Endosc. 2015;29(9):2770-2780</a></i>.<br> <br> Witteman BP, Kessing BF, Snijders G, Koek GH, Conchillo JM, Bouvy ND. Revisional laparoscopic antireflux surgery after unsuccessful endoscopic fundoplication. <i><a href="https://doi.org/10.1007/s00464-012-2685-6">Surg Endosc. 2013;27(6):2231-2236</a></i>.</p>

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