A Comparison of Laparoscopic Redo Fundoplications for Failed Toupet and Nissen Fundoplications in Children.

Purpose: We compared laparoscopic redo fundoplications performed for failed laparoscopic Toupet fundoplication (LTF) and failed laparoscopic Nissen fundoplications (LNFs).
Methods: Redo LTF (R-LTF; n = 4) and redo LNF (R-LNF; n = 6) performed between 2007 and 2014 were assessed retrospectively for severity of intraperitoneal adhesions on a scale of 0-3, identification/preservation of the anterior/posterior/hepatic branches of the vagus nerve (VN), complications, and outcome.
Results: Redos were performed after a mean of 34 months in R-LTF and 32 months in R-LNF ( P = ns) indicated for sliding hernia ( n = 3; 2 with partial wrap dehiscence) and partial wrap dehiscence ( n = 1) in R-LTF and sliding hernia ( n = 6; 4 with partial wrap dehiscence) in R-LNF. The mean adhesion severity score was 1.5 in R-LTF and 2.5 in R-LNF ( P < 0.05). The mean number of VN branches identified/preserved was 2.0 in R-LTF and 0.8 in R-LNF ( P < 0.05). Mean operative times and mean blood loss were similar. Intraoperative complications were accidental local trauma ( n = 1 in R-LTF and n = 3 in R-LNF, one requiring conversion to open repair) ( P = ns). Gastric outlet obstruction developed in two R-LNF cases; both were managed conservatively. There have been no further recurrences to date.
Conclusion: Although our series is small, adhesions were less, and identification/preservation of VN was easier during R-LTF.
Competing Interests: There are no conflicts of interest.