Anatomical failure following laparoscopic antireflux surgery (LARS): does it really matter?

INTRODUCTIONFailure rates of laparoscopic antireflux surgery (LARS) vary from 2–30%. A degree of anatomical failure is common, and the most common failure is intrathoracic wrap herniation. We have assessed anatomical integrity of the crural repair and wrap using marking Liga clips placed at the time of surgery and compared this with symptomatic outcome. PATIENTS AND METHODSA prospective study was undertaken on 50 patients who underwent LARS in a single centre over a 3-year period. Each had an X-ray on the first postoperative day and a barium swallow at 6 months at which the distance was measured between the marking Liga clips. An increase in interclip distance of > 25–49% was deemed ‘mild separation’, and an increase of > 50% ‘moderate separation’. Patients completed a standardised symptom questionnaire at 6 months. RESULTSAt 6 months' postoperatively, 22% had mild separation of the crural repair with a mean Visick score of 1.18, and 54% had moderate separation with a mean Visick score of 1.26. Mild separ...