A comprehensive review of laparoscopic redo fundoplication

The last decade has seen the publication of multiple case series investigating the feasibility of performing reoperative fundoplications using laparoscopic techniques. Most of these studies are small and reflect initial experiences with the procedure. To examine the collective experience with laparoscopic redo fundoplications, a systematic review was conducted. The MEDLINE, EMBASE, and Cochrane databases (January 1999 to March 2010) were reviewed. A total of 17 series representing 1,167 cases were selected. The mean patient age was 51.8 years, and 42.8% of the patients were men. The most common indication for reoperation was recurrent gastroesophageal reflux disease (GERD), and the most common etiology of failure was herniation of the wrap. The mean operative time was 172 min, and the mean hospital stay was 2.8 days. Intraoperative complications occurred in 18.6% of cases, and the most common complication was gastrointestinal perforations (14.2%). The rate of conversion from laparoscopic to open surgery was 7.4%. The average postoperative follow-up period was 18 months. Postoperative complications were encountered with 16.9% of the patients, and the most common categorized complication was incisional hernia (1.6%). Success rates, defined variably, averaged 81%. This review demonstrates that although technically challenging, redo laparoscopic fundoplication can be an effective tool in the operative management of clinically significant problems after primary fundoplication.