title: Reoperation rates after laparoscopic fundoplication.
abstract: BACKGROUND
  Current literature on redo antireflux surgery has limitations due to small sample size or single center experiences. This study aims to evaluate the reoperation rate of laparoscopic fundoplication in a large population database.
  
  
  METHODS
  A longitudinal version of the California Office of Statewide Health Planning and Development database from 1995 to 2010 was used. Inclusion criteria were patients who received a laparoscopic fundoplication for uncomplicated gastroesophageal reflux disease (GERD) or hiatal hernia. Patients were excluded if they had complications of GERD, esophageal or gastric cancer, prior esophageal or gastric surgery, vagotomy, esophageal dysmotility, and diaphragmatic hernia with gangrene or obstruction. The outcome was reoperation, specified as another fundoplication or reversal. Analysis was carried out via a Kaplan-Meier plot, hazard curve, and multivariate analysis adjusting for age, race, gender, comorbidities, insurance status, hospital teaching status, and year of procedure.
  
  
  RESULTS
  13,050 patients were included in the study. The 5 and 10-year cumulative reoperation rates were 5.2 % (95 % CI 4.8-5.7%) and 6.9 % (95 % CI 6.1-7.9%), respectively. Of these reoperations, 30 % were performed at a different hospital from that of the initial fundoplication. Reoperation rate was highest at 1 year post-operatively (1.7 % per year), and steadily declined until 4 years post-operatively, after which it remained at approximately 0.5 % per year. Multivariate analysis demonstrated significantly higher rates of reoperation among younger patients (HR = 3.56 for <30yo; HR = 1.89 for 30-50yo; HR = 1.65 for 50-65yo) and female patients (HR = 1.35).
  
  
  CONCLUSIONS
  Nearly one third of reoperations after failed laparoscopic fundoplication occur at a hospital different from the initial operation, which raises concern that existing literature does not reflect the true reoperation rate. The reoperation rate is highest in the first year postoperatively. The reasons for the higher rate of reoperation in females and younger patients remain unclear and warrant further study.
authors.affiliation: Department of General Surgery, Division of Minimally Invasive Surgery, Center for the Future of Surgery, University of California, San Diego, San Diego, CA, USA.
authors.forename: Tianzan
authors.initials: T
authors.lastname: Zhou
authors.forename: Cristina
authors.initials: C
authors.lastname: Harnsberger
authors.forename: Ryan
authors.initials: R
authors.lastname: Broderick
authors.forename: Hans
authors.initials: H
authors.lastname: Fuchs
authors.forename: Mark
authors.initials: M
authors.lastname: Talamini
authors.forename: Garth
authors.initials: G
authors.lastname: Jacobsen
authors.forename: Santiago
authors.initials: S
authors.lastname: Horgan
authors.forename: David
authors.initials: D
authors.lastname: Chang
authors.forename: Bryan
authors.initials: B
authors.lastname: Sandler
mesh_terms: D000328:Adult; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies