Several studies have addressed the performance of reoperative laparoscopic fundoplication.6,8-11 Some surgeons will attempt to perform all reoperative fundoplications laparoscopically, some will perform all reoperative fundoplications via thoracotomy, and some will perform all redo fundoplications through a laparotomy. We generally tailor our reoperative surgery according to the method used for the previous operation. That is, when the first operation was performed through a thoracotomy or with laparoscopy, the preferred approach is laparoscopic. When the first operation was performed through a laparo-tomy, our preferred approach is through a laparotomy, because when we approach this latter group through a thoracotomy, the intraabdominal adhesions make redo surgery difficult. When we perform the redo operation after laparotomy with laparoscopy, we have found that intraabdominal adhesions also make the laparoscopic procedure quite lengthy.6,10 Whether the redo fundoplication is performed laparoscopically or through a laparotomy, the operative principles are the same.
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