title: Revision of failed transoral incisionless fundoplication by subsequent laparoscopic Nissen fundoplication.
abstract: OBJECTIVE
  To evaluate the feasibility and outcomes of laparoscopic Nissen fundoplication after failed transoral incisionless fundoplication (TIF).
  
  
  METHODS
  TIF is a new endoscopic approach for treating gastroesophageal reflux disease (GERD). In cases of TIF failure, subsequent laparoscopic fundoplication may be required. All patients from 2010 to 2013 who had persistence and objective evidence of recurrent GERD after TIF underwent laparoscopic Nissen fundoplication. Primary outcome measures included operative time, blood loss, length of hospital stay and complications encountered.
  
  
  RESULTS
  A total of 5 patients underwent revisional laparoscopic Nissen fundoplication (LNF) or gastrojejunostomy for recurrent GERD at a median interval of 24 mo (range: 16-34 mo) after TIF. Patients had recurrent reflux symptoms at an average of 1 mo following TIF (range: 1-9 mo). Average operative time for revisional surgical intervention was 127 min (range: 65-240 min) and all surgeries were performed with a minimal blood loss (< 50 mL). There were no cases of gastric or esophageal perforation. Three patients had additional finding of a significant hiatal hernia that was fixed simultaneously. Median length of hospitalization was 2 d (range: 1-3 d). All patients had resolution of symptoms at the last follow up.
  
  
  CONCLUSIONS
  LNF is a feasible and safe option in a patient who has persistent GERD after a TIF. Previous TIF did not result in additional operative morbidity.
authors.affiliation: Awais Ashfaq, Hyun K (Daniel) Rhee, Kristi L Harold, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, United States.
authors.forename: Awais
authors.initials: A
authors.lastname: Ashfaq
authors.affiliation: Awais Ashfaq, Hyun K (Daniel) Rhee, Kristi L Harold, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, United States.
authors.forename: Hyun K Daniel
authors.initials: HK
authors.lastname: Rhee
authors.affiliation: Awais Ashfaq, Hyun K (Daniel) Rhee, Kristi L Harold, Department of Surgery, Mayo Clinic, Phoenix, AZ 85054, United States.
authors.forename: Kristi L
authors.initials: KL
authors.lastname: Harold
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D005240:Feasibility Studies; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods*; D015390:Gastric Bypass; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013997:Time Factors; D017211:Treatment Failure
keywords: Gastroesophageal reflux disease; Laparascopic Nissen fundoplication; Laparoscopy; Surgical complications; Transoral incisionless fundoplication