title: Review of the Experience with Re-Operation After Laparoscopic Nissen Fundoplication.
abstract: BACKGROUND
  The risk of redo fundoplication has been demonstrated to be significantly higher in patients of younger age, those with ongoing retching, and those who underwent more extensive dissection of the esophageal hiatus at the initial operation. The purpose of this study was to review the management and outcomes of patients who required one or more re-operations for recurrence after laparoscopic fundoplication.
  
  
  METHODS
  After obtaining Institutional Review Board approval, we performed a retrospective review of all patients who underwent laparoscopic Nissen fundoplication from 2000 to 2013 and subsequently required a redo operation for recurrence. Patient demographics, neurologic impairment, interval time between re-operations, operative approach, use of mesh, and length of follow-up were analyzed. Two-tailed independent Student's t test was used to compare continuous variables, and two-tailed chi-squared test with Yates's correction (Fisher's exact test where appropriate) was used for discrete variables.
  
  
  RESULTS
  Eighty-two patients (10.3% of the sample) required re-operation during the study period. The mean age at initial surgery was 1.8 ± 3.6 years. Fifteen patients (18.3%) required more than one re-operation. Of the 102 re-operations performed, 68 were successfully managed laparoscopically, 3 required conversion to an open procedure, and 31 were performed open from the outset. Of those patients requiring more than one re-operation, there was no difference in age, weight, use of mesh, or time to subsequent re-operations compared with patients that only required one redo fundoplication.
  
  
  CONCLUSIONS
  The incidence of patients requiring another operation after a redo operation after an initial laparoscopic fundoplication is 18%. Patient demographics and time to re-operation have not been found to be predictive of which patient will require multiple re-operations for recurrence. However, younger patients and those with a shorter time to re-operation may increase the likelihood of failure.
authors.affiliation: 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Amita A
authors.initials: AA
authors.lastname: Desai
authors.affiliation: 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Hanna
authors.initials: H
authors.lastname: Alemayehu
authors.affiliation: 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Brian G
authors.initials: BG
authors.lastname: Dalton
authors.affiliation: 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Katherine W
authors.initials: KW
authors.lastname: Gonzalez
authors.affiliation: 2 Department of Surgery, Creighton University , Omaha, Nebraska.
authors.forename: Brian
authors.initials: B
authors.lastname: Biggerstaff
authors.affiliation: 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: George W
authors.initials: GW
authors.lastname: Holcomb
authors.affiliation: 1 Department of Surgery, Children's Mercy Hospital , Kansas City, Missouri.
authors.forename: Shawn D
authors.initials: SD
authors.lastname: St Peter
mesh_terms: D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006551:Hernia, Hiatal / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D016896:Treatment Outcome