Laparoscopic redo Nissen fundoplication in infants and children

From January 1994 to December 2004, 118 patients with recurrent gastroesophageal reflux disease (GERD) after fundoplication underwent laparoscopic redo Nissen fundoplication. The patients ranged in age from 6 months to 19 years (mean, 7 years), and weighed from 6.4 to 85 kg. Of the 118 patients, 64 had previous open fundoplications, 53 had previous laparoscopic fundoplications, and 19 had more than one previous fundoplication. All the procedures had been successfully completed laparoscopically. The average operative time was 100 min. The intraoperative complication rate was 1.1%. The average time to full feeding was 1.8 days, and the average hospital stay was 2.2 days. The postoperative complication rate was 3.6%. The wrap failure rate during an average follow-up period of 48 months was 6%. Laparoscopic redo Nissen fundoplication for a failed antireflux procedure is a safe and effective procedure. It has the same benefits as a primary laparoscopic Nissen for GERD, with low morbidity and a quicker recovery. Early follow-up evaluation suggests that the long-term outcome is superior to that associated with open redo fundoplication.