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Invited Critique
March 1, 2008

Surgical Reintervention After Antireflux Surgery for Gastroesophageal Reflux Disease: A Prospective Cohort Study in 130 Patients—Invited Critique

Arch Surg. 2008;143(3):274. doi:10.1001/archsurg.2007.51

Furnée et al report, in one of the largest series of subsequent operations for failed antireflux procedures, an overall success rate of 70%. Considering the 90% or greater success rate reported for primary operations, these results can be seen as “the glass is half full” vs “the glass is half empty.”

On the “half full” side, one must assume that in a group of patients with either defective emptying or incompetent cardia in whom a previous operation has failed and other less invasive modalities have been tried and failed (presumably), a two-thirds success rate is an excellent outcome. Furthermore, among those who presented with abnormal gastroesophageal reflux disease, esophageal acid exposure was decreased by the subsequent operation from 11% (preoperatively) to approximately 4% (postoperatively) (<4.6% is considered normal).

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