title: Fever after redo Nissen fundoplication with hiatal hernia repair.
abstract: BACKGROUND
  Fevers often arise after redo fundoplication with hiatal hernia repair. We reviewed our experience to evaluate the yield of a fever work-up in this population.
  
  
  METHODS
  We performed a retrospective review of children undergoing redo Nissen fundoplication with hiatal hernia repair between December 2001 and September 2012. Temperatures and fever evaluations of those children receiving a mesh repair were compared with those without mesh. A fever defined as temperature ≥38.4°C.
  
  
  RESULTS
  Fifty one children received 46 laparoscopic, 4 open, and 1 laparoscopic converted to open procedures. Biosynthetic mesh was used in 25 children whereas 26 underwent repair without mesh. A fever occurred in 56% of those repaired with mesh compared with 23.1% without mesh (P = 0.02). A fever evaluation was conducted in 32% of those with mesh compared with 11.5% without mesh (P = 0.52). A urinary tract infection was identified in one child after mesh use and an infection was identified in two children without mesh, one pneumonia and one wound infection (P = 1). In those repaired with mesh, there was no significant difference in maximum temperature.
  
  
  CONCLUSIONS
  Fever is common after redo Nissen fundoplication with hiatal hernia repair and occurs more frequently, and with higher temperatures in those with mesh. Fever work-up in these patients is unlikely to yield an infectious source and is attributed to the extensive dissection during the redo procedure.
authors.affiliation: Department of Surgery, The Children's Mercy Hospital and Clinics, Kansas City, Missouri.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Sharp
authors.affiliation: Department of Surgery, The Children's Mercy Hospital and Clinics, Kansas City, Missouri.
authors.forename: Hanna
authors.initials: H
authors.lastname: Alemayehu
authors.affiliation: Department of Surgery, The Children's Mercy Hospital and Clinics, Kansas City, Missouri.
authors.forename: Amita
authors.initials: A
authors.lastname: Desai
authors.affiliation: Department of Surgery, The Children's Mercy Hospital and Clinics, Kansas City, Missouri.
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.affiliation: Department of Surgery, The Children's Mercy Hospital and Clinics, Kansas City, Missouri. Electronic address: sspeter@cmh.edu.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D002648:Child; D002675:Child, Preschool; D005334:Fever / Q000209:etiology*; D018662:Fundoplication; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D007223:Infant; D011183:Postoperative Complications / Q000209:etiology*; D012086:Reoperation / Q000009:adverse effects; D012189:Retrospective Studies
keywords: Fever; Hiatal hernia; Mesh; Nissen fundoplication; Pediatric