REDO LAPAROSCOPIC ANTIREFLUX SURGERY IN PATIENTS WITH HIATAL HERNIA

Summary. The purpose was to study the features and results of redo laparoscopic antireflux surgery in our clinic. Materials and methods. For the period from 2008 to 2019, in our clinic, laparoscopic antireflux operations were performed in 1164 patients. 54 patients underwent laparoscopic reoperation during the study period based on the following indications: recurrence of hiatal hernia (n = 38), recurrent reflux (n = 4), dysphagia (n = 8), severe pain (n = 5). All patients underwent repeated examinations in our clinic, telephone interviews, mailing of special questionnaires. All complaints were recorded, the quality of life was determined according to the GERD-HRQL questionnaire. Results. All redo operations were performed laparoscopically without conversion to laparotomy. Intraoperative complications were observed in 11.11 % of patients. Long-term follow up from 6 months to 6 years was observed in 90.74 % of patients. The quality of life of patients according to the GERD-HRQL questionnaire significantly improved in long-term follow-up (p <0.001). Good results were observed in 91.84 % of patients after redo operations. The third operation was needed in 5.6 % of patients. Conclusion. Redo laparoscopic antireflux operations are technically difficult surgical interventions, and should be performed by surgeons with big experience in the antireflux surgery. Laparoscopic antireflux surgery provide good long-term results in 90 % of patients.

P132 LARYNGOPHARYNGEAL PH MONITORING (RESTECH) MAY PREDICT A SUCCESSFUL SURGICAL OUTCOME FOR REGURGITATION AND OROPHARYNGEAL SYMPTOMS AFTER LAPAROSCOPIC ANTIREFLUX SURGERY

Introduction/Aim Laryngopharyngeal pH-monitoring (Restech) is a relatively new reflux testing device that needs more validation. It was developed to detect both liquid and acidic gas vapor, and the more consistent pharyngeal placement may lead to more reliable results, especially when laryngopharyngeal symptoms such as cough, hoarseness and globus sensation are present. Aim of this study is to determine if Restech can identify patients with a successful outcome for certain symptoms after antireflux surgery. Background and Methods In our esophageal center of excellence, more than 300 esophageal surgeries are performed annually. All patients are prospectively entered in our IRB approved database and undergo a routine check-up program with postoperative surveillance following surgery. All patients with suspicion for GERD received a complete diagnostic work-up for gastroesophageal reflux including symptom evaluation, endoscopy, 24-hour impedance pH-metry, high resolution manometry and Restech. Only patients with a complete dataset and oropharyngeal reflux symptoms were included in this study. Results A total of 155 [99 females] consecutive patients with suspected gastroesophageal reflux disease and oropharyngeal symptoms that were seen between 10/2013 and 08/2018 were included and underwent 24-h laryngopharyngeal with concomitant esophageal pH-monitoring. A total of 24 of these patients with laryngopharyngeal symptoms underwent laparoscopic antireflux surgery from 10/2013 - 02/2018 and had a complete follow up. Restech evaluation was abnormal in 62.5% (n=15, mean RYAN Score upright 121.73 [35.1-386.05], mean RYAN Score supine 5.74 [2.17-50.62]). Two out of preoperatively 12 [16.7%] patients with a pathologic Restech test complained about regurgitation after surgery versus 4 out of preoperatively 8 [50%] patients with a normal Restech result. No patient with an abnormal Restech result out of preoperatively 11 complained about extraesophageal symptoms after the surgery versus 1 from preoperatively 4 [25%] patients with a negative Restech. Conclusion An abnormal Restech result better identifies a successful outcome for regurgitation and extraesophageal symptoms after antireflux surgery. All patients had a complete resolution of extraesophageal symptoms after surgery.