Reoperative Foregut Surgery

Our experienced team of surgeons specialize in all types of complex reoperative foregut surgery.

Each case is discussed in detail at regularly scheduled conferences where our multidisciplinary team of surgeons and gastroenterologists identify the ideal reoperative strategy with the aid of cutting-edge imaging techniques, state-of-the-art equipment, and decades of medical and surgical expertise. The specifics of your previous therapeutic and surgical interventions will be reviewed and we will create an operative plan that is safest and most effective for your individual case.

Cause

The failure of previous hiatal hernia surgery can occasionally lead to the return of previous symptoms, or the development of new symptoms. Occasionally, there can be an early failure of surgery leading to more acute symptoms such as the sensation of food getting “stuck."

Many patients will have the mild return of pre-surgical symptoms and do not need a “redo” procedure, and the decision of further surgery is not made without significant multidisciplinary (surgery/GI) consultation.

Symptoms

Symptoms indicating the need for reoperative foregut surgery may include:

• Return of heartburn/GERD type symptoms
• The sensation of food getting stuck in the chest (dysphagia)
• Chest pain or abdominal pain particularly after eating
• Shortness of breath
• Dark or black stools which can be indicative of gastrointestinal bleeding
• Most concerning is the potential for “strangulation” where the stomach's blood supply is cut off. This is occasionally a result of the previous surgery and “surgical scar” formation

Risk Factors for Failure of Previous Surgery

Risk factors for reopereative foregut/hernia surgery include:

• Time from repair – increasing time can lead to breakdown
• Increasing weight gain or obesity can lead to breakdown of previous surgery
• Heavy lifting or “core/abdominal” exercises can lead to failure of previous surgery

Types of Failures

There are several types and forms of failed foregut surgeries:

• “Slipping” of the previous “wrap” onto the stomach or into the chest leading to the sensation of food getting stuck in the esophagus
• An “unwrapping” of the previous surgery causes a significant return of GERD type symptoms
• The stomach “herniating” or moving into the chest causing chest/abdominal pain or the above symptoms

Diagnosis/Workup

In considering a “redo” procedure, it is critical to perform comprehensive testing, often similar to testing performed prior to the initial surgery.

This testing includes an EGD, and measures of esophageal function (pH testing, manometry, barium swallow, and often gastric emptying studies).

Treatment

If determined that “redo” surgery is required, this can often be performed with minimally invasive techniques. This is a particular surgical strength of the Mass General staff.

Occasionally, particularly with third and fourth time “redo” operations, these procedures require a more traditional approach through an open incision, where Mass General surgeons are also expert and experienced.