Redo Interventions in Failed Procedures

Motility disorders of the esophagus are associated with a wide array of clinical presentations and treatment options. Surgical myotomy, either endoscopic or laparoscopic, is considered the mainstay of operative treatment for the majority of esophageal motility disorders. These techniques are associated with high rates of treatment success. Nevertheless, 10–20% of patients who are treated surgically for a motility disorder will develop recurrent symptoms in the years following their index operation. The reasons for these treatment failures are myriad and can be related to incomplete myotomy, failed fundoplications, new GERD (gastroesophageal reflux disease), scaring and fibrosis, megaesophagus development, or more rare entities like cancer development. When patients present with recurrent symptoms after surgical treatment for a motility disorder, they require a careful workup to determine the cause of their symptoms and define a tailored treatment course that will best suit each clinical scenario, whether that means medical or endoscopic management, redo surgery, or conversion to a new surgical approach.