title: Nissen fundoplication after failure of endoluminal fundoplication: short-term results.
abstract: BACKGROUND
  Endoluminal fundoplication (ELF) with EsophyX is a new attractive investigational procedure for the control of gastroesophageal reflux disease (GERD). The aim of this work is to evaluate the short-term results of Nissen fundoplication (NF) after failure of ELF.
  
  
  METHODS
  During the period April 2007-January 2010, nine patients previously treated with ELF for GERD were submitted to laparoscopic NF for persistent reflux.
  
  
  RESULTS
  All patients were symptomatic for GERD, had a pathological esophageal acid exposure at multichannel intraluminal impedance (MII pH/24 h), and all of them were on proton pump inhibitor. Mean duration of the NF was 85 min (range, 56-104). There were no intraoperative complications. One patient had a postoperative mild peritoneal bleeding treated conservatively. After a mean follow-up of 24.9 months (4-34), all patients are asymptomatic for reflux. Two patients have a mild or moderate dysphagia at follow-up. Five patients underwent MII pH/24 h 1 year after surgery. Mean total reflux time was 0.3%, and acid reflux percent time was 0.
  
  
  CONCLUSIONS
  Patients with persistent symptomatic reflux after a failing ELF can still undergo NF with good results; the endoluminal procedure does not seem to modify the results of the laparoscopic procedure, although an increased incidence of dysphagia pos-NF may be observed.
authors.affiliation: Minimally Invasive and General Surgery Unit, Istituto Clinico Humanitas (IRCCS), Milan, Italy. uberto.fumagalli@humanitas.it
authors.forename: Uberto
authors.initials: U
authors.lastname: Fumagalli Romario
authors.forename: Roberta
authors.initials: R
authors.lastname: Barbera
authors.forename: Alessandro
authors.initials: A
authors.lastname: Repici
authors.forename: Matteo
authors.initials: M
authors.lastname: Porta
authors.forename: Alberto
authors.initials: A
authors.lastname: Malesci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosati
mesh_terms: D000328:Adult; D000368:Aged; D017097:Electric Impedance; D016099:Endoscopy, Gastrointestinal; D004947:Esophagus; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012086:Reoperation / Q000379:methods; D011795:Surveys and Questionnaires; D017211:Treatment Failure