Reoperation after antireflux surgery: a population-based cohort study

Background Antireflux surgery for gastro-oesophageal reflux disease (GORD) and/or hiatal hernia is effective. Between 10 and 20 per cent of patients undergo reoperation for recurrent symptoms. Most studies are undertaken in a single centre and possibly underestimate the rate of reoperation. The aim of this nationwide population-based cohort study was to investigate long-term reoperation rates after antireflux surgery. Methods This study included patients who underwent antireflux surgery between 2000 and 2017 in Denmark, and were registered in the Danish nationwide health registries. Reoperation rates were calculated for 1, 5, 10 and 15 years after the primary antireflux operation for GORD and/or hiatal hernia. Duration of hospital stay, 30- and 90-day mortality and morbidity, and use of endoscopic pneumatic dilatation were assessed. Results This study included a total of 4258 antireflux procedures performed in 3717 patients. Some 3252 patients had only primary antireflux surgery and 465 patients underwent reoperation. The 1-, 5-, 10- and 15-year rates of repeat antireflux surgery were 3 center dot 1, 9 center dot 3, 11 center dot 7 and 12 center dot 8 per cent respectively. Thirty- and 90-day mortality rates were similar for primary surgery (0 center dot 4 and 0 center dot 6 per cent respectively) and reoperations. The complication rate was higher for repeat antireflux surgery (7 center dot 0 and 8 center dot 3 per cent at 30 and 90 days respectively) than primary operation (3 center dot 4 and 4 center dot 8 per cent). A total of 391 patients (10 center dot 5 per cent of all patients) underwent endoscopic dilatation after primary antireflux surgery, of whom 95 (24 center dot 3 per cent) had repeat antireflux surgery. Conclusion In this population-based study in Denmark, the reoperation rate 15 years after antireflux surgery was 12 center dot 8 per cent. Reoperations were associated with more complications.