Management of the problem patient after antireflux surgery.

Long-term follow-up studies have confirmed the efficacy and durability of properly performed operations for gastroesophageal reflux; however, a significant number of patients develop trouble-some postoperative symptoms. Recurrent acid reflux and heartburn, dysphagia, gas bloat, diarrhea, and sliding and/or paraesophageal hernias may require medical or surgical intervention. Whereas some of these problems are transient, most require complete re-evaluations, and many require reoperations, ideally performed by surgeons with experience of these complex cases.