title: The risk of mortality following secondary fundoplication in a population-based cohort study.
abstract: BACKGROUND
  Mortality following laparoscopic fundoplication has been found to be negligible. However, some patients require secondary fundoplication, and the risk of mortality following such procedure is scarcely studied.
  
  
  METHODS
  This nationwide Swedish population-based cohort study included all patients undergoing secondary fundoplication following primary laparoscopic fundoplication in 1997 to 2013, regardless of indication. Primary outcome was mortality within 90 days of surgery, and secondary outcome was postoperative length of hospital stay.
  
  
  RESULTS
  A total of 9,765 patients underwent primary laparoscopic fundoplication, 540 (5.5%) patients underwent secondary fundoplication. About 382 (70.7%) were conducted laparoscopically, and 158 (29.3%) were conducted with an open technique. No deaths occurred within 90 days of the secondary fundoplication. Median length of stay was longer following secondary fundoplication (4.8 days, interquartile range 1.0 to 5.0 days), compared to primary laparoscopic fundoplication (2.5 days, interquartile range 1.0 to 3.0 days).
  
  
  CONCLUSIONS
  This population-based cohort study indicates that secondary fundoplication following primary laparoscopic fundoplication is a safe procedure. The longer hospital stay following secondary fundoplication compared to primary laparoscopic fundoplication is likely explained by the higher rate of open surgical approach.
authors.affiliation: Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden. Electronic address: John.Maret.Ouda@ki.se.
authors.forename: John
authors.initials: J
authors.lastname: Maret-Ouda
authors.affiliation: Department of Molecular Medicine and Surgery, Upper Gastrointestinal Surgery, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden; Division of Cancer Studies, Gastrointestinal Cancer, King's College London, UK.
authors.forename: Jesper
authors.initials: J
authors.lastname: Lagergren
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000401:mortality*; D005764:Gastroesophageal Reflux / Q000401:mortality* / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012086:Reoperation / Q000009:adverse effects / Q000401:mortality; D013548:Sweden
keywords: Fundoplication; Gastroesophageal reflux disease; Laparoscopic surgery; Safety