title: Transthoracic repair of slipped Nissen fundoplications: technique and results.
abstract: BACKGROUND
  Laparoscopic Nissen fundoplication is a common operation performed for reflux disease, generally with good results. A small percentage of patients experience transthoracic migration of the wrap, causing recurrent symptoms and eventually requiring transthoracic repair.
  
  
  METHODS
  A retrospective chart review was performed for all patients who underwent a transthoracic repair of a slipped Nissen fundoplication at our institution from 2006 to 2010. Data included demographics, previous antireflux operations, symptoms at presentation, findings at operation, and overall outcome.
  
  
  RESULTS
  Sixteen patients with a mean age of 61 years (range, 51-76 years) were identified who fit inclusion criteria. The most common presenting symptom was pain. Intraoperative findings included hiatal breakdown in all patients, shortened esophagus in 10 (62%) patients, and foreign body/mesh in 4 (25%) patients. Nine (56%) patients underwent a Collis gastroplasty along with a Nissen fundoplication. Nissen fundoplication alone was performed in 6 (38%) patients and a Belsey fundoplication with a Collis gastroplasty was performed in 1 (6%) patient. Minor complications occurred in 4 (25%) patients and major complications were seen in 2 (13%) patients. The median length of stay was 9 days (range, 6-30 days). There were no postoperative deaths. Overall, 12 (75%) of the patients were judged to have a good outcome, 3 (19%) a fair outcome, and 1 (6%) a poor outcome over a median 9-month follow-up.
  
  
  CONCLUSIONS
  Transthoracic repair in patients who have had transthoracic migration of a previous Nissen fundoplication has acceptable surgical outcome and affords symptomatic relief to the majority of patients.
authors: Department of Cardiothoracic Surgery, University of Texas Health Science Center, San Antonio, Texas 78229, USA. purir@uthscsa.edu
authors: Ruchir
authors: R
authors: Puri
authors: Adam M
authors: AM
authors: Cline
authors: Daniel T
authors: DT
authors: DeArmond
authors: Scott B
authors: SB
authors: Johnson
mesh_terms: D000368:Aged; D004868:Equipment Failure; D005260:Female; D005548:Foreign-Body Migration / Q000601:surgery*; D018662:Fundoplication / Q000009:adverse effects* / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019616:Thoracic Surgical Procedures / Q000379:methods; D017211:Treatment Failure