Laparoscopic reoperation on failed antireflux procedures: report of two patients.

Two cases are presented that demonstrate the feasibility of using the laparoscopic transabdominal approach for failed antireflux procedures. The first patient had two previous Belsey hemifundoplications that had both failed and had intractable reflux unresponsive to conservative treatment. The Belsey operation was taken down and a floppy Nissen fundoplication performed; the patient had only transient postoperative dysphagia. The second patient had a standard floppy Nissen fundoplication performed over a large bougie and developed a postoperative motility problem that failed to respond to medication and dilation. The Nissen was taken down laparoscopically and converted to a Toupet procedure; the patient had total relief of the dysphagia. Neither patient had intra-abdominal complications, and both have had total relief of their heartburn and regurgitation.