Long-term outcomes following failure of Nissen fundoplication
Topic overview
Retrospective study of 190 pediatric patients requiring reintervention after failed Nissen fundoplication found that 63% underwent redo fundoplication, with success rates declining after each attempt. Patients previously managed with gastro-jejunal feeding had significantly higher rates of redo fundoplication failure, suggesting surgical reintervention should be avoided in this group when symptom-free on jejunal feeds.
Key takeaways
- 23% of pediatric Nissen fundoplications require further intervention for GOR, typically at median 21 months post-op
- Success rates decline with each redo fundoplication attempt; prior GJ tube placement predicts higher failure risk (67% vs 33%, p=0.005)
- Patients symptom-free on jejunal feeds should avoid further anti-reflux surgery due to poor outcomes with subsequent fundoplication
- Of patients requiring redo procedures, 63% underwent second fundoplication after median 15 months; GJ tubes require ~2 changes/year
- For multiply-failed fundoplications, options include long-term GJ feeding, esophagogastric dissociation, or gastric pacing
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