Literature review: revisional anti-reflux surgery


  • Neha Gauri Department of Surgery, Wagga Wagga Base Hospital, Wagga NSW, Australia



Gastrectomy, Fundoplication, Reflux


Revision anti-reflux surgery is challenging. With higher rates of complications and lower rates of symptoms control, patient selection is critical. With Roux-en-Y gastrectomy and re-fundoplication being the most commonly performed procedures, there is no clear guidance on operative selection base on patient characteristics.  A literature review was performed of the PubMed database with search terms ‘reflux’, ‘gastrectomy’, and ‘fundoplication’. Of the 164 results, 17 studies were deem suitable for inclusion. In the limited studies available, Roux-en-Y gastrectomy was shown to have higher rates of symptoms control but was also associated with higher rates of complications compared to re-fundoplication. Primary studies assessing the safety and efficacy of gastrectomy as a salvage surgery option are limited. Within the available evidence, select patient groups may benefit from Roux-en-Y gastrectomy over re-fundoplication.


Braghetto I, Csendes A. Failure after Fundoplication? Is there a room for Gastrectomy? In which clinical Scenarios? Arquivos brasileiros de cirurgia digestive. Brazilian Arch Digestive Surg. 2019;32(2):e1440.

Braghetto I, Csendes A, Burdiles P, Botero F, Korn O. Results of surgical treatment for recurrent postoperative gastroesophageal reflux. Diseases Esophagus J Int Society Dis Esophagus. 2002;15(4):315-22.

Csendes A, Bragheto I, Burdiles P, Smok G, Henriquez A, Parada F. Regression of intestinal metaplasia to cardiac or fundic mucosa in patients with Barrett's esophagus submitted to vagotomy, partial gastrectomy and duodenal diversion. A prospective study of 78 patients with more than 5 years of follow up. Surgery. 2006;139(1):46-53.

DePaula AL, Hashiba K, Bafutto M, Machado CA. Laparoscopic reoperations after failed and complicated antireflux operations. Surgical Endoscopy. 1995;9(6):681-6.

Du X, Wu JM, Hu ZW, Wang F, Wang ZG, Zhang C et al. Laparoscopic Nissen (total) versus anterior 180° fundoplication for gastro-esophageal reflux disease: A meta-analysis and systematic review. Medicine. 2017;96(37):e8085.

Falk GL, Van der Wall H, Burton L, Falk MG, O'Donnell H, Vivian SJ. Fundoplication for laryngopharyngeal reflux despite preoperative dysphagia. Ann Royal College Surgeons Eng. 2017;99(3):224-7.

Frazzoni M, Piccoli M, Conigliaro R, Frazzoni L, Melotti G. Laparoscopic fundoplication for gastroesophageal reflux disease. World J Gastroenterol. 2014;20(39):14272-9.

Furnée EJ, Draaisma WA, Broeders IA, Gooszen HG. Surgical reintervention after failed antireflux surgery: a systematic review of the literature. J Gastrointestinal Surg. 2009;13(8):1539-49.

Gallusi G, Pontone S. Treatment of PPI-resistant gastro-oesophageal reflux: A systematic review. Arab J Gastroenterol. 2018;19(2):51-5.

Khallouf J, Gaspar Figueiredo S, Demartines N, Schoepfer A, Schäfer M, Mantziari S. Gastroesophageal reflux disease in obese patients; current management. Revue Medicale Suisse. 2020;16(699):1287-91.

Khoma O, Falk SE, Burton L, Van der Wall H, Falk GL. Gastro-Oesophageal Reflux and Aspiration: Does Laparoscopic Fundoplication Significantly Decrease Pulmonary Aspiration? Lung. 2018;196(4):491-6.

Nadaleto BF, Herbella FA, Patti MG. Gastroesophageal reflux disease in the obese: Pathophysiology and treatment. Surg. 2016;159(2):475-86.

Nirwan JS, Hasan SS, Babar ZU, Conway BR, Ghori MU. Global Prevalence and Risk Factors of Gastro-oesophageal Reflux Disease (GORD): Systematic Review with Meta-analysis. Scientific reports, 2020;10(1):5814.

Makris KI, Lee T, Mittal SK. Roux-en-Y reconstruction for failed fundoplication. J Gastrointestinal Surg. 2009;13(12):2226-32.

Mendes-Filho AM, Godoy E, Alhinho H, Galvão-Neto M, Ramos AC, Ferraz Á et al. Fundoplication conversion in Roux-en-Y gastric bypass for control of obesity and gastroesophageal reflux: Systematic Review, Arquivos brasileiros de cirurgia digestive. Brazilian Arch Digestive Surg. 2017;30(4):279-82.

Mindermann T, Schuppisser JP, Tondelli P. Partial gastrectomy and Roux-en-Y anastomosis in recurrence of reflux following fundus plication. Schweizerische Medizinische Wochenschrift, 1989;119(21):742-3.

Mittal SK, Légner A, Tsuboi K, Juhasz A, Bathla L, Lee TH. Roux-en-Y reconstruction is superior to redo fundoplication in a subset of patients with failed antireflux surgery. Surgical endoscopy, 2013;27(3):927-35.

Munie S, Nasser H, Gould JC. Salvage Options for Fundoplication Failure. Cur Gastroenterol Rep. 2019;21(9):41.

Smith CD, McClusky DA, Rajad MA, Lederman AB, Hunter JG. When fundoplication fails: redo? Ann Surg. 2010;241(6):861-71.

Tack J, Pandolfino JE. Pathophysiology of Gastroesophageal Reflux Disease. Gastroenterology. 2018;154(2):277-88.

Tai CM, Lee YC, Wu MS, Chang CY, Lee CT, Huang CK et al. The effect of Roux-en-Y gastric bypass on gastroesophageal reflux disease in morbidly obese Chinese patients. Obesity Surg. 2009;19(5):565-70.

Williams VA, Watson TJ, Gellersen O, Feuerlein S, Molena D, Sillin LF et al. Gastrectomy as a remedial operation for failed fundoplication. J Gastrointestinal Surg. 2007;11(1):29-35.

Yamamoto SR, Hoshino M, Nandipati KC, Lee TH, Mittal SK. Long-term outcomes of reintervention for failed fundoplication: redo fundoplication versus Roux-en-Y reconstruction. Surgical Endoscopy. 2014;28(1):42-8.






Review Articles