Review Laparoscopic revision of failed antireflux surgery: a systematic review Nicholas R. A. Symons, M.Sc., M.R.C.S. a , Sanjay Purkayastha, M.D., M.R.C.S. a , Bruno Dillemans, M.D. b , Thanos Athanasiou, Ph.D., F.E.C.T.S. a , George B. Hanna, Ph.D., F.R.C.S. a , Ara Darzi, K.B.E., M.D., F.A.C.S. a , Emmanouil Zacharakis, M.D., Ph.D. a, * a Department of Surgery and Cancer, Imperial College London, St. Mary’s Hospital, Academic Surgical Unit, 10th Floor, QEQM Building, South Wharf Rd., London, W2 1NY UK; b Department of General, Laparoscopic and Bariatric Surgery, AZ Sint-Jan Hospital, Brugge, Belgium Abstract BACKGROUND: Laparoscopic antireflux surgery is an accepted treatment for persistent gastroesoph- ageal reflux but about 4% of patients will eventually require revision surgery. METHODS: We searched The Cochrane Collaboration, Medline, and EMBASE databases, aug- mented by Google Scholar and PubMed related articles from January 1, 1990, to November 22, 2010. Twenty studies met the inclusion criteria, reporting on 930 surgeries. RESULTS: The mean surgical duration was 166 minutes and conversion to open revision fundopli- cation was required in 7% of cases. Complications were reported in 14% of cases and the mean length of stay varied between 1.2 and 6 days. A good to excellent result was reported for 84% of surgeries and 5% of patients required a further revisional procedure. CONCLUSIONS: Laparoscopic revision antireflux surgery appears to be feasible and safe, but subject to somewhat greater risk of conversion, higher morbidity, longer hospital stay, and poorer outcomes than primary laparoscopic fundoplication. © 2011 Elsevier Inc. All rights reserved. KEYWORDS: Laparoscopy; Fundoplication; Gastroesophageal reflux; Reoperation; Recurrence; Systematic review Laparoscopic fundoplication is well accepted as the gold standard treatment for severe gastroesophageal re- flux. It appears to be more efficacious 1 and less expen- sive 2 than ongoing medical therapy. Unfortunately, be- tween 2.8% and 4.4% of patients undergoing laparoscopic fundoplication at a specialist center will require late reoperation for persistent or recurrent symp- toms 3–5 and there may be an increased revision rate after primary laparoscopic antireflux surgery compared with an initial open approach. 6 It is estimated that nearly 24,000 antireflux surgeries were performed in the United States in 2003, 7 which suggests that approximately 1,000 revision surgeries are required annually. Revision of failed antireflux surgery increasingly is being performed laparoscopically, but data about this approach are limited. This systematic review assessed the available evidence for the feasibility, safety, and efficacy of laparoscopic revision of failed antireflux surgery in adults. * Corresponding author. Tel.: +44 (0)20-331-21012; fax: +44 (0)20- 331-26950. E-mail address: e.zacharakis@imperial.ac.uk Manuscript received December 17, 2010; revised manuscript March 30, 2011 0002-9610/$ - see front matter © 2011 Elsevier Inc. All rights reserved. doi:10.1016/j.amjsurg.2011.03.006 The American Journal of Surgery (2011) 202, 336 –343