Background: Laparoscopic Nissen fundoplication has become the standard of care for medically refractory gastroesophageal reflux disease (GERD). While the procedure is highly effective, complications may occur necessitating reoperation. Results of laparoscopic re-do operations have been reported in the literature, most of which are relatively small single-institution case-series. The purpose of this study was to review published reports of laparoscopic re-do fundoplications in order to cumulatively analyze peri-operative and intraoperative findings and outcomes.Methods: A systematic search was performed of the PubMed Medline, Ovid and Cochrane Clinical databases from January 1999 to August 2008. Only primary studies with data on more than 25 laparoscopic re-do procedures were included. Subject demographics, pre-operative indications, intraoperative findings and peri-operative complications were extracted from each study and entered into a database. Descriptive analyses were performed. Results: The literature search yielded 98 potential studies. After application of exclusion criteria and abstract review, 16 qualified studies reporting a total of 1,099 cases were selected for the final analysis. Mean patient age was 50.8 years and 43.5% were male. The most common indication for re-do operation was recurrent GERD with the most common etiology of anatomic failure being herniation of the wrap. Mean operative time was 206 minutes and mean hospital stay (LOS) was 3.2 days. Conversion rate from laparoscopic to open was 7.7%. Intraoperative complications were reported in 17.6% of cases with the most common being gastrointestinal perforations (15.5%). Post-operative follow-up averaged 21 months. Post-operative complications were encountered in 18% of patients with the most common categorized complication being incisional hernia (4.7%). The average reported success rate was 81% as determined by either subjective patient reporting or objective test criteria.Conclusions: Laparoscopic re-do Nissen fundoplication is a feasible corrective procedure for patients who have technical complications after undergoing a primary Nissen. The most common presenting symptom necessitating re-do laparoscopic fundoplication was recurrent GERD with the most common etiology being herniation of the fundoplication wrap. Re-do operations are technically challenging as demonstrated by prolonged operating times and LOS, a conversion rate of 8%, and intraoperative complications in 18%. Ultimately, satisfactory outcomes were experienced by over 80% of patients at medium-term follow-up.