Recurrence after laparoscopic and open Nissen fundoplication: a comparison of the mechanisms of failure.
BACKGROUND
Laparoscopic Nissen fundoplication as treatment for gastroesophageal reflux disease (GERD) in adults has a reported recurrence rate of 2-17%. We investigated the rates and mechanisms of failure after laparoscopic Nissen fundoplication in children.


METHODS
All patients who underwent a laparoscopic Nissen fundoplication for GERD and who subsequently required a redo Nissen were reviewed (n = 15). The control group consisted of the most recent 15 patients who developed recurrent GER after an open Nissen, fundoplication.


RESULTS
Between 1994 and 2000, laparoscopic Nissen fundoplication was performed in 179 patients. Fifteen patients (8.7%) underwent revision. The mechanisms of failure were herniation in four patients, wrap dehiscence in four, a too-short wrap in three, a loosened wrap in two, and other reasons in two. The reoperation was performed laparoscopically in five patients (33%). The failure mechanisms were different in the open patients: eight were due to slipped wraps; three to dehiscences; and two to herniations.


CONCLUSIONS
The failure rate after laparoscopic Nissen is acceptably low. A redo laparoscopic Nissen can be performed safely after an initial laparoscopic approach.
Graziano
K
K
Department of Surgery, Section of Pediatric Surgery, the C. S. Mott Children's Hospital, University of Michigan, F3970, Box 0245, Ann Arbor, MI 48109, USA.
Teitelbaum
D H
DH
McLean
K
K
Hirschl
R B
RB
Coran
A G
AG
Geiger
J D
JD
D002648:Child; D002675:Child, Preschool; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000209:etiology; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects* / Q000379:methods* / Q000706:statistics & numerical data; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017211:Treatment Failure