title: Laparoscopic fundoplication in neonates and young infants: Failure rate and need for redo at a high-volume center.
abstract: OBJECTIVE
  Present the outcomes of patients younger than 2years who underwent laparoscopic fundoplication, highlighting the failure rate and need for redo fundoplication.
  
  
  METHODS
  Retrospective review of patients <2years who underwent laparoscopic fundoplication between January 2009 and December 2014.
  
  
  RESULTS
  458 infants younger than 2years underwent laparoscopic fundoplication in the 6-year period (360 Nissen, 77 Toupet and 21 Thal fundoplications). Median age at surgery was 5 (1-23) months. Median follow-up was 3 (1-6) years. The conversion rate was 0.87% (4 of 458 cases). Patients did not undergo routine studies to assess the incidence of postoperative GER but were instead followed clinically. Failure of the fundoplication was determined when a patient was unable to gain weight and/or protect the airway while receiving gastric feedings because of GER. The failure rate in our experience was 2.6% (12 redo out of 458 cases [11/360 Nissen, 1/77 Toupet and 0/21 Thal]). All failed cases occurred because of migration of the fundoplication, confirmed preoperatively by a contrast study. Median time between the initial fundoplication and the redo was 13 (5-27) months. There were no failures within a contemporaneous group of 101 patients <2years who underwent open fundoplication.
  
  
  CONCLUSIONS
  The need for a redo fundoplication after a laparoscopic fundoplication was an uncommon event in our experience (12 of 458 cases). Our results contrast with published studies that report higher failure rates. Case volume per surgeon may explain in part the dissimilar results among studies.
  
  
  METHODS
  III.
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA. Electronic address: laje@email.chop.edu.
authors.forename: Pablo
authors.initials: P
authors.lastname: Laje
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA.
authors.forename: Thane A
authors.initials: TA
authors.lastname: Blinman
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Nance
authors.affiliation: Division of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, USA.
authors.forename: William H
authors.initials: WH
authors.lastname: Peranteau
mesh_terms: D002675:Child, Preschool; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D008297:Male; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D017211:Treatment Failure
keywords: Failure rate; Infants; Laparoscopic fundoplication; Redo fundoplication