Question of the week from Reginald in Houston: I had surgery for hiatal hernia in 2014. I re-experienced reflux after 15 months and began taking Omeprazole. This seemed to work. In the last 4 months other symptoms have begun and my surgeon had me go for and Upper G.I. The surgeon says I have a slipped Nissen fundoplication. Next week I’m scheduled for a robotic surgery conversion from Nissen to Toupet fundoplication, possible gastropexy and redo hiatal hernia repair with possible mesh placement. How successful and durable is revision surgery? Will heartburn reoccur?
Dear Reginald,
There is no difference in laparoscopic Nissen fundoplication and hiatal hernia surgery outcome when performed with or without a robotic platform. What determine heartburn surgery outcome are surgeon skills and experience as well as surgical technique. Slipped Nissen fundoplication shortly after primary repair is almost always secondary to poor esophageal mobilization. Slipped Nissen fundoplication is non-existent in my practice at Houston Heartburn and Reflux Center. I have performed more than 1000 Nissen fundoplications and hiatal hernia repairs.
I general, the success rate of Nissen fundoplication and hiatal hernia repair decreases after each revision. However, redo hiatal hernia and Nissen fundoplication surgery is particularly effective in the setting of poor prior esophageal mobilization. I rarely need to convert Nissen to Toupet fundoplication during revision surgery. I always prefer a full wrap over partial wrap because of better durability. However, I offer Toupet fundoplication if part of gastric fundus is resected during revision surgery and there isn’t enough gastric fundus tissue to perform a floppy Nissen fundoplication. In most cases, a Nissen or 360-degree wrap can be redone without any difficulty or problem. I almost never use gastropexy unless patient has had history of gastric volvulus. Gastropexy does very little in terms of preventing hiatal hernia and heartburn recurrence.
If revision surgery is properly performed, hiatal hernia repair and Nissen fundoplication are durable, and heartburn is not likely to recur.