A multicenter study of the incidence and factors associated with redo Nissen fundoplication in children

Abstract Aim The objective of this study was to identify the incidence and factors associated with redo Nissen fundoplication in children. Methods After Institutional Review Board approval (5100277), data for children under 18 years of age from two children's hospitals with fundoplication performed between January 1994 and December 2010 were reviewed. Children with one fundoplication were compared to those with redos to identify factors associated with redo. Variables were compared using t-tests for continuous and chi-square tests for categorical variables. Logistic regression evaluated for independence. Results There were 823 patients and 54.7% were male. A redo fundoplication was required in 100 (12.2% of cohort); 82 had 1 redo, 14 had 2 redos, and 4 had 3 redos. Follow-up ranged from 0.01 to 16.9 years (median: 2.9 years). Factors associated with redo were: younger age at first fundoplication, (p = 0.002), hiatal dissection (p < 0.001), and male gender (p = 0.008). Independent predictors of redo were: hiatal dissection at first fundoplication, OR: 8.45 (95% CI: 2.45–29.11), retching, OR: 3.59 (95% CI: 1.56–8.25) and younger age at first fundoplication, OR: 0.98 (95% CI: 0.97–0.98). Conclusion The incidence of redo fundoplication in children is 12.2%. The risk of redo is significantly increased if patients are younger, have retching, and if the esophageal hiatus is dissected at the first fundoplication.