Feasibility and surgical considerations for conversion to the refluxstop procedure following failure of prior antireflux surgery in GERD patients: an analysis of 24 cases

Introduction: Antireflux surgery (ARS) can result in postoperative complications such as recurrent reflux, dysphagia, explantation or migration/erosion of surgical devices, and reherniation, which may necessitate redo surgery. Current ARS approaches have conceivably high reoperation rates, with repeat surgeries typically showing less favorable outcomes than primary procedures. Physiological and technical considerations of ARS may restrict future treatment options when failure occurs.

Objectives: To report the feasibility and surgical considerations for conversion to RefluxStop surgery after failed ARS.

Methodology: Retrospective analysis evaluated the feasibility of RefluxStop surgery in GERD patients (N=24) after prior ARS, including Nissen or alternative fundoplication, magnetic sphincter augmentation (MSA), EndoStim, and BICORN.

Results: RefluxStop surgery was feasible and straightforward in all cases, regardless of the type of prior ARS failure (Table 1). All patients were well-treated and discontinued proton pump inhibitors postoperatively. Takedown of all fundoplication techniques was straightforward with minor variations, after which the RefluxStop procedure was performed as recommended. Meticulous handling of the vagal nerves is imperative, with varying extents of gastroesophageal adhesion dissection. Nissen requires dissection of all gastroesophageal attachments, whereas Toupet and Dor require less dissection, involving at least the right-dorsal gastroesophageal attachments and restricted adherence dissection, respectively. Although differing from fundoplication in key aspects, conversion from MSA was uncomplicated, requiring dissection of fibrotic encapsulation from the 8-4 o’clock, followed by laparoscopic MSA removal before RefluxStop surgery. When converting from EndoStim, the device and electrodes were easily removed due to minimally invasive device implantation. Conversion from BICORN, like that of Dor fundoplication, was technically less challenging and involved pre-dissection of the gastroesophageal attachment. One early device penetration into the gastric cavity occurred, likely due to a worn-out fundus, with segments of the device passing naturally through the digestive tract.

Conclusions: Conversion to RefluxStop was feasible and safe in all cases. Redo surgery with RefluxStop is straightforward regardless of prior ARS type and particularly facile for MSA and EndoStim ([Abb. 1]).

Abb. 1  

Publication History

Article published online:
04 September 2025