title: A multicenter study of the incidence and factors associated with redo Nissen fundoplication in children.
abstract: OBJECTIVE
  The objective of this study was to identify the incidence and factors associated with redo Nissen fundoplication in children.
  
  
  METHODS
  After Institutional Review Board approval (5100277), data for children under 18 years of age from two children's hospitals with fundoplication performed between January 1994 and December 2010 were reviewed. Children with one fundoplication were compared to those with redos to identify factors associated with redo. Variables were compared using t-tests for continuous and chi-square tests for categorical variables. Logistic regression evaluated for independence.
  
  
  RESULTS
  There were 823 patients and 54.7% were male. A redo fundoplication was required in 100 (12.2% of cohort); 82 had 1 redo, 14 had 2 redos, and 4 had 3 redos. Follow-up ranged from 0.01 to 16.9 years (median: 2.9 years). Factors associated with redo were: younger age at first fundoplication, (p=0.002), hiatal dissection (p<0.001), and male gender (p=0.008). Independent predictors of redo were: hiatal dissection at first fundoplication, OR: 8.45 (95% CI: 2.45-29.11), retching, OR: 3.59 (95% CI: 1.56-8.25) and younger age at first fundoplication, OR: 0.98 (95% CI: 0.97-0.98).
  
  
  CONCLUSIONS
  The incidence of redo fundoplication in children is 12.2%. The risk of redo is significantly increased if patients are younger, have retching, and if the esophageal hiatus is dissected at the first fundoplication.
authors.affiliation: Loma Linda University Children's Hospital, Loma Linda, CA 92354, USA. jbaerg@llu.edu
authors.forename: Joanne
authors.initials: J
authors.lastname: Baerg
authors.forename: Donna
authors.initials: D
authors.lastname: Thorpe
authors.forename: Gilberto
authors.initials: G
authors.lastname: Bultron
authors.forename: Rosemary
authors.initials: R
authors.lastname: Vannix
authors.forename: E Marty
authors.initials: EM
authors.lastname: Knott
authors.forename: Alessandra C
authors.initials: AC
authors.lastname: Gasior
authors.forename: Susan W
authors.initials: SW
authors.lastname: Sharp
authors.forename: Edward
authors.initials: E
authors.lastname: Tagge
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods / Q000706:statistics & numerical data*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D016015:Logistic Models; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012306:Risk; D017211:Treatment Failure
keywords: Pediatric gastroesophageal reflux disease; Redo Nissen fundoplication