title: Laparoscopic redo nissen fundoplication after previous open antireflux surgery in infants and children.
abstract: Recurrent gastroesophageal reflux is a common complication after fundoplication procedures. We report our experience with laparoscopic redo Nissen fundoplications in pediatric patients with a history of open antireflux procedure. The medical records of all patients with a history of open antireflux procedure who underwent a subsequent laparoscopic redo Nissen fundoplication were reviewed. One hundred eighty laparoscopic Nissen fundoplications were performed between September 2004 and September 2012; 23 were redo procedures. Twelve patients had a history of prior open fundoplication. Average time between operations was 113.7±64 months. Seven patients presented with emesis, 4 with aspiration pneumonia, and 1 with clinical reflux. Eight had a history of cerebral palsy and/or seizure disorder. Laparoscopic revision was completed in 100% of the patients, with no intraoperative complications. Average operative time was 177.5±86 minutes. Seven patients were able to resume feeds on postoperative Day 1. Median length of stay was 3 days. Median follow-up was 21 months. One patient required a redo antireflux procedure 8 months later for persistent dysphagia. Thus laparoscopic revision Nissen fundoplication after a prior open antireflux procedure is feasible and safe.
authors.affiliation: Department of Surgery, Kaiser Permanente Los Angeles Medical Center , Los Angeles, California.
authors.forename: Amy W
authors.initials: AW
authors.lastname: Cheng
authors.forename: Donald B
authors.initials: DB
authors.lastname: Shaul
authors.forename: Stanley T
authors.initials: ST
authors.lastname: Lau
authors.forename: Roman M
authors.initials: RM
authors.lastname: Sydorak
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004947:Esophagus / Q000601:surgery; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006551:Hernia, Hiatal / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay; D008297:Male; D061646:Operative Time; D011859:Radiography; D012086:Reoperation; D012189:Retrospective Studies; D055815:Young Adult