Evaluation of laparoscopic management of recurrent gastroesophageal reflux disease and hiatal hernia: long term results and evaluation of changing trends.

Background: Recurrent gastro-esophageal reflux disease (GERD) following fundoplication remains a common problem. This study evaluates a long-term experience with laparoscopic management of these cases.

Methods: From January 1994 to December 2012, 252 patients with recurrent GERD underwent a laparoscopic redo Nissen (LRN) fundoplication with average age of 6.8years. Eighty-four had previous open fundoplications and 144 previous LNRs. Thirty-two had more than one previous fundoplication.

Results: All procedures were completed laparoscopically. The average operative time was 82min. The intra-operative complication rate was 5.1%, the most common being a gastrostomy during the mobilization. The average time to full feeds was 1.4days, and the average hospital stay was 1.6days. The post-operative complication rate was 3.6%. The wrap failure rate was 6.2%. The most common cause of wrap failure was H/H, with increasing incidence of slipped wrap during the second half. The highest recurrence rate was in patients receiving their LNR before 4months of age.

Conclusions: Redo Laparoscopic Nissen fundoplication is safe and effective, with the same benefits as a primary laparoscopic Nissen, with low morbidity and quick recovery. A change in the etiology of recurrence suggests that there is a failure to adequately identify and mobilize the GE junction in laparoscopic cases.