Evaluation of laparoscopic management of recurrent gastroesophageal reflux disease and hiatal hernia: long term results and evaluation of changing trends.
BACKGROUND
Recurrent gastro-esophageal reflux disease (GERD) following fundoplication remains a common problem. This study evaluates a long-term experience with laparoscopic management of these cases.


METHODS
From January 1994 to December 2012, 252 patients with recurrent GERD underwent a laparoscopic redo Nissen (LRN) fundoplication with average age of 6.8years. Eighty-four had previous open fundoplications and 144 previous LNRs. Thirty-two had more than one previous fundoplication.


RESULTS
All procedures were completed laparoscopically. The average operative time was 82min. The intra-operative complication rate was 5.1%, the most common being a gastrostomy during the mobilization. The average time to full feeds was 1.4days, and the average hospital stay was 1.6days. The post-operative complication rate was 3.6%. The wrap failure rate was 6.2%. The most common cause of wrap failure was H/H, with increasing incidence of slipped wrap during the second half. The highest recurrence rate was in patients receiving their LNR before 4months of age.


CONCLUSIONS
Redo Laparoscopic Nissen fundoplication is safe and effective, with the same benefits as a primary laparoscopic Nissen, with low morbidity and quick recovery. A change in the etiology of recurrence suggests that there is a failure to adequately identify and mobilize the GE junction in laparoscopic cases.
The Rocky Mountain Hospital for Children at Presbyterian/St Luke's, Denver, CO, USA.
Samiksha
S
Bansal
The Rocky Mountain Hospital for Children at Presbyterian/St Luke's, Denver, CO, USA. Electronic address: steverberg@aol.com.
Steven S
SS
Rothenberg
D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D004943:Esophagogastric Junction / Q000473:pathology; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology; D007441:Intubation, Gastrointestinal; D010535:Laparoscopy / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013524:Surgical Flaps; D013536:Suture Techniques; D000267:Tissue Adhesions / Q000601:surgery; D016896:Treatment Outcome
Fundoplication; Gastroesophageal reflux; Hiatal hernia; Laparoscopy; Redo Nissen