Evaluation and Treatment of the Patient with Recurrent Symptoms

Clinically significant symptoms after previous anti-reflux surgery include heartburn, regurgitation, dysphagia, pain, and gas bloating. Management of these symptoms will depend greatly on the timing and duration of these symptoms and their severity. Often, they may be attributed to functional gastric or esophageal issues, undiagnosed preoperative conditions, anatomic abnormalities resulting from surgery, or conditions that develop or are exacerbated after surgery. A complete evaluation of these symptoms includes any combination of esophagram, upper endoscopy, esophageal manometry, ambulatory pH monitoring, gastric emptying studies, and CT imaging. Management includes symptomatic treatment with medications, endoscopic therapy, or redo anti-reflux surgery.