title: Laparoscopic revision of failed fundoplication and hiatal herniorraphy.
abstract: OBJECTIVE
  The aim of this study was to evaluate the mechanisms of failure after laparoscopic fundoplication and the results of revision laparoscopic fundoplication.
  
  
  BACKGROUND
  Laparoscopic Nissen fundoplication has become the most commonly performed antireflux procedure for the treatment of gastroesophageal reflux disease, with success rates from 90 to 95%. Persistent or new symptoms often warrant endoscopic and radiographic studies to find the cause of surgical failure. In experienced hands, reoperative antireflux surgery can be done laparoscopically. We performed a retrospective analysis of all laparoscopic revision of failed fundoplications done by the principle author and the respective fellow within the laparoscopic fellowship from 1992 to 2006.
  
  
  METHODS
  A review was performed on patients who underwent laparoscopic revision of a failed primary laparoscopic fundoplication.
  
  
  RESULTS
  Laparoscopic revision of failed fundoplication was performed on 68 patients between 1992 and 2006. The success rate of the laparoscopic redo Nissen fundoplication was 86%. Symptoms prior to the revision procedure included heartburn (69%), dysphagia (8.8%), or both (11.7%). Preoperative evaluation revealed esophagitis in 41%, hiatal hernia with esophagitis in 36%, hiatal hernia without esophagitis in 7.3%, stenosis in 11.74%, and dysmotility in 2.4%. The main laparoscopic revisions included fundoplication alone (41%) or fundoplication with hiatal hernia repair (50%). Four gastric perforations occurred; these were repaired primarily without further incident. An open conversion was performed in 1 patient. Length of stay was 2.5 +/- 1.0 days. Mean follow-up was 22 months (range, 6-42), during which failure of the redo procedure was noted in 9 patients (13.23%).
  
  
  CONCLUSIONS
  Laparoscopic redo antireflux surgery, performed in a laparoscopic fellowship program, produces excellent results that approach the success rates of primary operations.
authors.affiliation: Department of Surgery, Northwestern University, Chicago Institute of Minimally Invasive Surgery, Skokie, Illinois, USA. cfrantzides@cimis.info
authors.forename: Constantine T
authors.initials: CT
authors.lastname: Frantzides
authors.forename: Atul K
authors.initials: AK
authors.lastname: Madan
authors.forename: Mark A
authors.initials: MA
authors.lastname: Carlson
authors.forename: Tallal M
authors.initials: TM
authors.lastname: Zeni
authors.forename: John G
authors.initials: JG
authors.lastname: Zografakis
authors.forename: Ronald M
authors.initials: RM
authors.lastname: Moore
authors.forename: Mick
authors.initials: M
authors.lastname: Meiselman
authors.forename: Minh
authors.initials: M
authors.lastname: Luu
authors.forename: Georgios D
authors.initials: GD
authors.lastname: Ayiomamitis
mesh_terms: D000328:Adult; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D049671:History, 18th Century; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D012086:Reoperation; D012189:Retrospective Studies; D017211:Treatment Failure; D016896:Treatment Outcome