Digestive System Commons^™

Vasculature Of The Anterior Abdominal Wall And Surface Anatomy Of The Liver And Stomach: Considerations For Minimal Access Surgeries In Neonates, Daniël J. Van Tonder, Natalie Keough, Martin Louis Van Niekerk, Albert Van Schoor

COM Scholarship

Background: Minimal access surgeries are growing more common in neonatal care, but the risk of accidental injury to abdominal wall blood vessels remains a concern. This risk is increased by limited precise anatomical data specific to neonates. Therefore, this study aimed to quantitatively map the superficial and deep blood vessels of the neonatal anterior abdominal wall concerning important surgical landmarks to develop evidence-based recommendations for safer laparoscopic port placement. Methods: Thirty formalin-fixed low-birth-weight neonatal body donations (≤4 weeks old) were dissected. An anatomical grid based on palpable landmarks—including the umbilicus, xiphoid process, and anterior superior iliac spines—was utilised to measure …

Comparison Of Fully Covered Self-Expandable Metal Biliary Stents With Or Without Anchoring Double-Pigtail Plastic Stents: A Systematic Review And Meta-Analysis, Samuel Tanner, Fadi Hawa, Alejandra Vargas, Priyata Dutta, Antonio Facciorusso, Jean M. Chalhoub, Jorge D. Machicado

Department of Medicine Faculty Publications

Background and AIMS

Fully covered self-expandable metal stents (FcSEMSs) have become the mainstay of treatment for a variety of biliary pathologies. However, FcSEMSs have been associated with a greater rate of stent migration than other types of stents. A technique of anchoring double-pigtail plastic stents (DPPSs) has been proposed to minimize migration of biliary FcSEMSs. Herein, we evaluated the efficacy of anchoring DPPSs among patients treated with biliary FcSEMSs.

Methods

We performed a systematic review using PubMed, EMBASE, and Web of Science from database inception through August 2023. Full-text articles comparing FcSEMSs with or without anchoring DPPSs were included. We …

Probiotic Intervention In Managing Chronic Stress, Bianca Opdenbosch

PANDION: The Osprey Journal of Research and Ideas

Chronic stress can induce gut dysbiosis which contributes to the dysregulation of the gut-brain axis and leads to anxiety and depressive-like symptoms. The gut-brain axis relies on nervous, immune, and endocrine interactions. Gut dysbiosis, an imbalance within the gut microbiome, disrupts gut-brain communication, impairing gut barrier integrity, inflammation regulation, and hormonal and neurotransmitter production. These gut changes contribute to mood disorders resulting from stress, and thus it is important to implement dietary interventions, like probiotics, to help mitigate these effects. Research highlights the potential of probiotics to act as an intervention to combat stress-induced gut dysbiosis and replenish beneficial bacteria …

Wernicke’S Encephalopathy With Classic Triad And Normal Mri In A Young Woman Following Rapid-Sequence Bariatric And Biliary Surgery, Hugo Zamarron, Nina Mourao, Roberto A. Cruz Saldana

Research Colloquium

Background: Wernicke’s encephalopathy is a life-threatening neurological disorder caused by thiamine deficiency, most commonly associated with alcoholism. However, postoperative nutritional deficiencies in young patients undergoing bariatric procedures are increasingly recognized. This case is unique due to the rapid succession of bariatric and cholecystectomy surgeries, development of classic Wernicke’s symptoms with a normal MRI, and diagnostic delay due to overlapping differential diagnoses including intracranial hypotension and myelopathy.

Case Presentation: A 22-year-old woman with class III obesity underwent sleeve gastrectomy in July 2022, followed by significant weight loss and persistent intractable vomiting. Due to suspected gallbladder disease, she underwent a cholecystectomy in …

Redefining The Albumin-Bilirubin Score: Predictive Modeling And Multidimensional Integration In Liver And Systemic Disease, Berkay Demirors, Ramin Shekouhi, Paola Berrios Jimenez, Anjali Yadav, Guido Chiriboga, Vishal A. Mahesh, Harsheen K. Manaise, Jade Bowers, Angel Aguayo Merly, Emmanuel Gabriel

School of Medicine Faculty Publications

This editorial comment is on the article by Xu et al. It offers an in-depth analysis of liver function assessment tools and their prognostic roles in non-malignant liver diseases, with a focus on the albumin-bilirubin (ALBI) score. ALBI’s components, grading system, and clinical relevance across various liver conditions are reviewed and compared with traditional models such as the Child-Pugh and model for end-stage liver disease scores. We included recent studies evaluating ALBI’s role in estimating liver function, suggesting it may help differentiate patients who appear similar under other staging systems, and assist in guiding clinical decisions. Although ALBI is primarily …

Early Recurrent Midgut Volvulus Post Ladd's Procedure In A Newborn: A Case Report, Nicole Clarke, Joanna Sajdlowska, John Paul Bustamante, Nishith Bhattacharyya

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Ladd's procedure is the standard surgical intervention for intestinal malrotation. Although generally curative, rare cases of early postoperative complications, including adhesions or recurrent volvulus, can necessitate reoperation. We present the case of a full-term newborn girl who underwent emergent Ladd's procedure on Day 3 of life for malrotation with volvulus. She was discharged on postoperative Day 17 but returned the following day with recurrent bilious emesis. Imaging suggested partial obstruction. Exploratory laparotomy revealed recurrent volvulus with two twists at the duodenojejunal junction, which was successfully reduced. The patient recovered well and was discharged on postoperative Day 8. This case underscores …

The Gut Microbiome And Knee Osteoarthritis: A Review Of Emerging Pathophysiologic Links, Krisha S. Patel, Maduka Gunasinghe, Umer Shah, Kushkumar K. Patel, Zarif Ladak

Rowan-Virtua Research Day

Background

Knee osteoarthritis (OA), a multifactorial degenerative joint disease with growing prevalence in aging and obese populations, leads to disabling pain. Traditionally viewed as mechanically driven, increasing research implicates systemic inflammation and metabolic and neuroimmune modulation. The gut microbiome—an ecosystem of commensal organisms regulating host immune, metabolic, and inflammatory regulation—has emerged as a potential contributor to OA pathogenesis and symptom severity. This review aims to synthesize literature evaluating associations between gut microbiota composition and knee OA, focusing on inflammatory pathways, pain modulation, and emerging therapies.

Methods

A literature search was conducted using PubMed, Embase, Scopus, and Web of Science. Inclusion …

Aortoduodenal Syndrome: A Rare Case Of Duodenal Obstruction Due To Endovascular Aneurysm Endoleak., Raksha Adhikari, Parth Patel, Christopher Tait

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Aortoduodenal syndrome results from expansion of an abdominal aortic aneurysm, leading to symptoms of upper gastrointestinal obstruction. Endovascular aneurysm repair of large or symptomatic aortic aneurysms has become an important treatment modality for patients with abdominal aortic aneurysm. However, a large proportion of these grafts are complicated by endoleaks that can lead to a spectrum of significant symptoms. We present a case of rapidly worsening gastrointestinal obstructive symptoms in a patient with an already repaired aortic stent graft and a solitary kidney, found to be due to a type III endoleak that improved after emergent repeat endovascular aneurysm repair.

Surgical Management Of Gastroenteropancreatic Neuroendocrine Tumors, Lisa M. Kenney, Marybeth Hughes

Department Surgery Faculty Publications

Background/Objectives: Neuroendocrine tumors (NETs) are heterogeneous malignancies arising from enterochromaffin cells that can arise from the gastrointestinal (GI) tract and pancreas. Surgical management is the cornerstone of treatment, with the optimal approach tailored by tumor grade, size, location, and presence of metastasis. This review discusses the current strategies for the surgical management of NETs of the gastroenteropancreatic tract. Methods: A review of the available literature was conducted to evaluate surgical approaches to NETs. Consensus guidelines were incorporated to synthesize evidence-based recommendations. Results: For gastric NETs, surgical approach depends on Rindi Classification, WHO grade, and tumor size, with endoscopic approaches favored …

Pancreaticoduodenectomy In Trauma Patients With Grade Iv-V Duodenal Or Pancreatic Injuries: A Post Hoc Analysis Of An East Multicenter Trial, Rachel Leah Choron, Charoo Piplani, Julia Kuzinar, Amanda L. Teichman, Christopher Bargoud, Jason D. Sciarretta, Randi N. Smith, Dustin Hanos, Iman N. Afif, Jessica H. Beard, Navpreet Kaur Dhillon, Ashling Zhang, Mira Ghneim, Rebekah Devasahayam, Oliver Gunter, Alison A. Smith, Brandi Sun, Chloe S. Cao, Jessica K. Reynolds, Lauren A. Hilt, Daniel N. Holena, Grace Chang, Meghan Jonikas, Karla Echeverria-Rosario, Nathaniel S. Fung, Aaron Anderson, Caitlin A. Fitzgerald, Ryan Peter Dumas, Jeremy H. Levin, Et Al

School of Medicine Faculty Publications

INTRODUCTION: The utility of pancreaticoduodenectomy (PD) for high-grade traumatic injuries remains unclear and data surrounding its use are limited. We hypothesized that PD does not result in improved outcomes when compared with non-PD surgical management of grade IV-V pancreaticoduodenal injuries. METHODS: This is a retrospective, multicenter analysis from 35 level 1 trauma centers from January 2010 to December 2020. Included patients were ≥ 15 years of age with the American Association for the Surgery of Trauma grade IV-V duodenal and/or pancreatic injuries. The study compared operative repair strategy: PD versus non-PD. RESULTS: The sample (n=95) was young (26 years), male …

A Case Of Cecal Volvulus In The Setting Of Multiple Sclerosis, S. Jiaming Lin, Paige M. Kieper, Michael Mullinax, Jake W. Vogel, Kimberly Syres

Advances in Clinical Medical Research and Healthcare Delivery

This case report describes a patient with a history of multiple sclerosis (MS) and optic neuritis, who presented with acute onset of generalized abdominal pain. The patient was ultimately diagnosed with cecal volvulus requiring emergent laparotomy and right hemicolectomy. This case highlights the relationship between neurogenic bowel dysfunction (NBD) associated constipation in patients with MS and intestinal volvulus. Additionally, this case demonstrates the importance of NBD associated constipation management through various modalities including laxative regimens, behavioral and diet modification, and reduction of polypharmacy, with an emphasis on individualized patient management.

Bilio-Cecal Stent Migration Presenting As Massive Rectal Bleeding., Lefika Bathobakae, Shady Geris, Mohita Jariwala, Mansi Patel, Jessica Escobar, Ruhin Yuridullah, Kamal Amer, Yana Cavanagh

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Endoscopic biliary stenting is a well-established intervention for the treatment of biliary, hepatic, and pancreatic disorders. The common indications include strictures, neoplasms, stones, infections, and bile leaks. Stents can be occluded, predisposing patients to ascending cholangitis and biliary sepsis. Distal stent migration is another known complication of endoscopic stenting and is usually spontaneous. Bowel perforation, abscesses, bleeding, and pancreatitis are rare complications of distal stent migration and are usually limited to the duodenum. Herein, we describe an extremely rare case of bilio-cecal stent migration presenting as rectal bleeding.

Blastomas Of The Digestive System In Adults: A Review, Yu Liu, Tony El Jabbour, Jonathan Somma, Yukihiro Nakanishi, Saverio Ligato, Hwajeong Lee, Zhi-Yan Fu

School of Medicine Faculty Publications

Blastomas, characterized by a mixture of mesenchymal, epithelial, and undifferentiated blastematous components, are rare malignant neoplasms originating from precursor blast cells. This review focuses on digestive system blastomas in adult patients, including gastroblastoma, hepatoblastoma, and pancreatoblastoma. Gastroblastoma is a biphasic, epitheliomesenchymal tumor, with only sixteen cases reported to date. In addition to the characteristic histology, metastasis-associated lung adenocarcinoma transcript 1 - glioma-associated oncogene homolog 1 gene fusion is typical, although recently novel ewing sarcoma breakpoint region 1 - c-terminal binding protein 1 and patched 1 - glioma-associated oncogene homolog 2 fusions have been described. Hepatoblastoma is exceptionally rare in adults …

Limonene Exerts Anti-Inflammatory Effect On Lps-Induced Jejunal Injury In Mice By Inhibiting Nf-Κb/Ap-1 Pathway, Sarmed H. Kathem, Yasameen Sh. Nasrawi, Shihab H. Mutlag, Surya M. Nauli

Pharmacy Faculty Articles and Research

The human gastrointestinal system is a complex ecosystem crucial for well-being. During sepsis-induced gut injury, the integrity of the intestinal barrier can be compromised. Lipopolysaccharide (LPS), an endotoxin from Gram-negative bacteria, disrupts the intestinal barrier, contributing to inflammation and various dysfunctions. The current study explores the protective effects of limonene, a natural compound with diverse biological properties, against LPS-induced jejunal injury in mice. Oral administration of limonene at dosages of 100 and 200 mg/kg was used in the LPS mouse model. The Murine Sepsis Score (MSS) was utilized to evaluate the severity of sepsis, while serum levels of urea and …

Machine Learning As A Tool For Early Detection: A Focus On Late-Stage Colorectal Cancer Across Socioeconomic Spectrums, Hadiza Galadima, Rexford Anson-Dwamena, Ashley Johnson, Ghalib Bello, Georges Adunlin, James Blando

Community & Environmental Health Faculty Publications

Purpose: To assess the efficacy of various machine learning (ML) algorithms in predicting late-stage colorectal cancer (CRC) diagnoses against the backdrop of socio-economic and regional healthcare disparities. Methods: An innovative theoretical framework was developed to integrate individual- and census tract-level social determinants of health (SDOH) with sociodemographic factors. A comparative analysis of the ML models was conducted using key performance metrics such as AUC-ROC to evaluate their predictive accuracy. Spatio-temporal analysis was used to identify disparities in late-stage CRC diagnosis probabilities. Results: Gradient boosting emerged as the superior model, with the top predictors for late-stage CRC diagnosis being anatomic site, …

Socioeconomic Status And Health Disparities Drive Differences In Accelerometer-Derived Physical Activity In Fatty Liver Disease And Significant Fibrosis, Lucia Tabacu, Sajag Swami, Mark Ledbetter, Mohamad S. Siddiqui, Ekaterina Smirnova

Mathematics & Statistics Faculty Publications

Background and aims

The cornerstone of clinical management of patients with nonalcoholic fatty liver disease (NAFLD) are lifestyle changes such as increasing physical activity (PA) aimed at improving cardiometabolic risk. To inform NAFLD prevention and treatment guidelines we aimed to: (i) quantify the role of PA on lowering the risk for NAFLD and fibrosis; (ii) characterize NAFLD and fibrosis association with PA in the context of socioeconomic environment.

Methods

A sample of 2648 participants from the NHANES 2003–2006 was selected to develop survey weighted multivariable logistic regression models for predicting NAFLD and significant fibrosis, diagnosed non-invasively via fatty liver index …

Successful Surgical Outcome After Traumatic Diaphragmatic Intra-Pericardial Herniation From Blunt Abdominal Injury, Tyler Bayliss, Mark H. Cooper, Paul Bown

Marshall Journal of Medicine

Intrapericardial diaphragmatic hernia (IPDH) is a rare manifestation of non-hiatal diaphragmatic hernias (NHDH). Intrapericardial diaphragmatic hernia is defined as the prolapse of the abdominal viscera into the pericardium through the diaphragm. Their incidence has increased over the last 50-60 years, secondary to high-speed transport, and constitutes 5% of major thoracic and abdominal trauma today. These injuries can present during the initial workup or months after the initiating injury. These hernias can be caused by both blunt and penetrating trauma with concomitant central tendon rupture and pericardial laceration. We report an interesting case of intrapericardial diaphragmatic hernia with delayed presentation that …

Early Closure Of Colostomy From Abdominal Trauma May Be Beneficial In Otherwise Healthy Patients, Nicole Xu

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising

Khalid MS, Moeen S, Khan AW, Arshad R, Khan AF. Same admission colostomy closure: a prospective, randomised study in selected patient groups. Surgeon. 2005;3(1):11-14. https://doi.org/10.1016/s1479-666x(05)80004-6

for a patient with loop transverse colostomy due to trauma

Identifying The Serious Clinical Outcomes Of Adverse Reactions To Drugs By A Multi-Task Deep Learning Framework, Haochen Zhao, Peng Ni, Qichang Zhao, Xiao Liang, Di Ai, Shannon Erhardt, Jun Wang, Yaohang Li, Jiianxin Wang

Computer Science Faculty Publications

Adverse Drug Reactions (ADRs) have a direct impact on human health. As continuous pharmacovigilance and drug monitoring prove to be costly and time-consuming, computational methods have emerged as promising alternatives. However, most existing computational methods primarily focus on predicting whether or not the drug is associated with an adverse reaction and do not consider the core issue of drug benefit-risk assessment-whether the treatment outcome is serious when adverse drug reactions occur. To this end, we categorize serious clinical outcomes caused by adverse reactions to drugs into seven distinct classes and present a deep learning framework, so-called GCAP, for predicting the …

Appendiceal Diverticulum Masquerading As Acute Appendicitis, Aesha Patel, Asad Abbas, Ratul Bhattacharyya, Dana Galaktionova

Rowan-Virtua Research Day

Appendiceal diverticula present as rare clinical findings and are most often confused with acute appendicitis due to similar presentation. The incidence in such cases is reported at a rate no greater than 1%.

We present a rare case of a 65-year-old female treated for acute appendicitis who was instead found to have acute sequelae of appendiceal diverticulosis.

Effectiveness Of Stabilized Hypochlorous Acid In Acute Peritonitis Treatment: A Murine Surgical Study, Benjamin Michael Pomeroy

Graduate Theses/Dissertations

Peritonitis is an inflammatory condition affecting the mesothelial cells that line the peritoneal cavity and is commonly induced by bowel perforations. This medical emergency is treated through antibiotic therapy and surgical intervention followed by tissue irrigation (lavage). Acute treatments aim to remove the bacterial burden, however recurring peritoneal infections occur at high rates and contribute to patient morbidity. These recurring infections are likely due to the inability of lavage solutions to remove the entire massive intra-abdominal bacterial load due to intestinal perforation. Numerous antiseptic solutions and antibiotic additives have been evaluated in their ability to improve source control by abdominal …

Ctrp3 And Alcoholic Liver Disease In Female Mice, Callie Root

Undergraduate Honors Theses

C1q TNF Related Protein 3 (CTRP3), is a cytokine that is primarily secreted from adipose tissue, which classifies it as an adipokine. Our previous research has shown that CTRP3 prevents alcoholic fatty liver disease (ALD) in male mice. However, even when accounting for confounding factors such as absolute and relative alcohol intake, females are more sensitive to the effects of consumption compared to male mice. Therefore, the goal of this project was to determine whether CTRP3 prevented ALD in female mice. Methods: Female wild type (WT) and female CTRP3 transgenic over expressing (Tg) mice were fed an ethanol containing liquid …

Safe And Effective Use Of A Hands-Free Intracorporeal Retractor For Suture-Based Liver Retraction During Minimally Invasive Bariatric Procedures: Results Of A Large Case Series, Roger De La Torre, Matthew Sappington, Tom Smith, Jeremy Bryner, David Mantilla, J Stephen Scott

General Surgery

Background

Laparoscopic bariatric surgery requires retraction of the left lobe of the liver to provide adequate operative view and working space. Conventional approaches utilize a mechanical retractor that requires a dedicated incision, may cause liver damage, and often requires an assistant. This study evaluated the safety and efficacy of hands-free intracorporeal retractors in a large series of subjects undergoing laparoscopic bariatric surgery. This method eliminates the need for a subxiphoid incision, enables full surgeon autonomy, and allows for adjustments throughout the procedure.

Methods

Retrospective chart review identified all subjects at a single hospital undergoing bariatric surgery between September 2017-March 2019 …

Toothpick Perforation Of Colon Mimicking Acute Appendicitis, Jacob Wilson, Adeshola Fakulujo

Rowan-Virtua Research Day

This study presents a case report of a rare complication of foreign body ingestion and offers a literature review of management options. Pre-operative imaging and clinical history was reviewed. During diagnostic laparoscopy the diagnosis of ascending colon perforation with a foreign body was made and managed with a Laparoscopic Right Hemicolectomy. Literature was reviewed for case of toothpick ingestion requiring intervention, foreign body ingestion causing perforation, and management of foreign body perforations.

A Rare Manifestation Of A Bleeding Tubulovillous Duodenal Polyp Presenting As An Upper Gastrointestinal Hemorrhage, Neethi Dasu, Yaser Khalid, Herman Suga, Michael Itidiare, Richard Walters

Rowan-Virtua Research Day

• Duodenal polyps are a group of polyps that are fairly uncommon to find on endoscopic evaluation (1).

• They are histologically classified according to mucin phenotype into intestinal and gastric subtypes; the intestinal-type polyps are morphologically subdivided into tubular and tubulovillous adenomas (2)

• We present a case of a 76-year-old male with recurrent hematemesis who was found to have an intestinal-type pedunculated tubulovillous adenoma (TVA) in the descending duodenum • An isolated occurrence of non-ampullary sporadic duodenal adenomas (SDA)’s are a rare finding and presentation as an upper GI hemorrhage is extremely uncommon (3)

• Furthermore, our patient’s …

Suffering In Silence: Is Gastroparesis Underdiagnosed?, Dennis J. Baumgardner

Journal of Patient-Centered Research and Reviews

In this introduction to Volume 6, Issue 2, the editor-in-chief of the Journal of Patient-Centered Research and Reviews offers additional comment to the clinical review of diabetic gastroparesis authored by Farmer and colleagues (p. 148), regarding the problem of undiagnosed disease. Increased awareness of this entity and appropriate questioning regarding symptoms of diabetic gastroparesis in the primary care setting may prevent the “suffering in silence” experienced by many patients with this complication.

Aortoduodenal Fistula Forms From Primary Aortic Stump Graft In A Two-Time Multi-Visceral Transplant Patient With Presentation Of Gastrointestinal Bleed And Bowel Perforation: A Case Report, Brielle Corrente

Graduate Student Research Symposium

Usually not diagnosed until open laparotomy, aortoduodenalfistulas (ADF) are one of the rarest complications of intestinal transplant surgery. With an incidence rate of only 0.04% at autopsy and only 250 documented cases since the early 1800’s, aortoduodenal fistulas are the most deadly complications of intestinal transplantation with a mortality rate of 100% without surgical intervention. A 39 year old, two-time multi-visceral transplant African American female patient suffered from a primary aortoduodenal fistula formation in a primary modified multi-visceral transplant aortic stump graft site. With emergency open laparotomy repair, revascularization of the secondary multi-visceral transplant was performed, saving the life of …

Rectal Colonic Mural Hematoma Following Enema For Constipation While On Therapeutic Anticoagulation., Rebecca M. Rentea, Charles H. Fehring

Manuscripts, Articles, Book Chapters and Other Papers

Causes of colonic and recto-sigmoid hematomas are multifactorial. Patients can present with a combination of dropping hemoglobin, bowel obstruction and perforation. Computed tomography imaging can provide clues to a diagnosis of intramural hematoma. We present a case of rectal hematoma and a review of current management literature. A 72-year-old male on therapeutic anticoagulation for a pulmonary embolism, was administered an enema resulting in severe abdominal pain unresponsive to blood transfusion. A sigmoid colectomy with end colostomy was performed. Although rare, colonic and recto-sigmoid hematomas should be considered as a possible diagnosis for adults with abdominal pain on anticoagulant therapy.

Bleeding Meckel's Diverticulum In Children: The Diagnostic Value Of Double-Balloon Enteroscopy., Lan-Lan Geng, Pei-Yu Chen, Qiang Wu, Hui-Wen Li, Ding-You Li, Min Yang, Si-Tang Gong

Manuscripts, Articles, Book Chapters and Other Papers

Background. Meckel's diverticulum (MD) is the most common congenital anomaly of the gastrointestinal tract. The purpose of this study was to evaluate the diagnostic value and safety of double-balloon enteroscopy (DBE) for bleeding MD in children. Methods. We included consecutive children who were highly suspected of MD between 2012 and 2013. All patients underwent Meckel's scan. DBE was performed for patient with negative Meckel's scan. An exploratory laparoscopy was performed in children with positive Meckel's scan or DBE. Results. 42 patients met the inclusion criteria. 40 patients were confirmed to have MD by exploratory laparoscopy. Meckel's scan …

Outcomes After Pediatric Fundoplication: Defining The Redo Population, J E. Baerg, E E. Perrone, R A. Vannix, D L. Thorpe, A Gasior, Shawn D. St Peter

Manuscripts, Articles, Book Chapters and Other Papers

Objective: The aims were to compare outcome variables in children with gastroesophageal reflux disease (GERD) and one Nissen fundoplication to children with redo fundoplications and define the pediatric redo population. Methods: After IRB approval (#5100277), a case control study was conducted of children younger than 18 years, from two children’s hospitals, with one Nissen fundoplication (control group) or a redo performed between January 1995 and March 2011. Complete data were collected by phone calls to caregivers in December 2012. Only redo operations performed after recurrence of GERD symptoms and wrap herniation into the mediastinum confirmed by contrast radiograph were included. …