Perspectives in clinical gastroenterology and hepatologyGastroesophageal Reflux Disease Treatment: Side Effects and Complications of Fundoplication
Section snippets
General Mortality, Morbidity, and Conversion Rate to Open Operation
By all measures, laparoscopic antireflux surgery is a safe operation when performed by experienced surgeons. Postoperative 30-day mortality is rare, and among available reports it is usually <1%.1 By using the U.S. Nationwide Inpatient Sample (20% stratified sample of U.S. nonfederal hospitals recording 5–8 million hospital stays from about 1000 hospitals each year), we reported the inpatient mortality after antireflux surgery decreased from 0.82% in 1993 to 0.26% in 2000, but it increased to
Acute Perioperative and Immediate Postoperative Complications
Poor functional outcome after antireflux surgery usually can be traced to inadequate patient selection or technical problems encountered during the operation. In other cases, a different set of complications become manifest clearly during the operation or immediately postoperatively and potentially can lead to significant morbidity if not immediately recognized and treated.12
Gas-bloat Syndrome
The gas-bloat syndrome comprises an ill-defined and variable group of complaints assumed to result from the inability to vent gas from the stomach into the esophagus after fundoplication. The predominant complaint is bloating, but other symptoms include abdominal distention, early satiety, nausea, upper abdominal pain, flatulence, inability to belch, and inability to vomit. The cause of the syndrome is unclear, but proposed mechanisms include (1) inability of the surgically altered
Revisional Antireflux Surgery
Although long-term results with antireflux surgery are generally good, especially if performed by experienced surgeons, failures are unavoidable. Most failures occur within the first 2 years of the initial operation.1 In large reviews, the most common symptoms are recurrent heartburn and/or dysphagia, with pain and bloating being less common.10, 42
Figure 1 illustrates several of the primary patterns of fundoplication failures.43 Herniation of the fundoplication into the chest (type 1A) is the
Conclusions
The success of antireflux surgery requires disciplined cooperation between the gastroenterologist and surgeon to avoid potential pitfalls (Table 2). The gastroenterologist must select the appropriate patients on the basis of careful and thorough esophageal function testing. The surgeon must be skilled in the technical nuances of laparoscopic surgery and not reluctant to convert to an open laparotomy when problems occur. Nevertheless, complications occur after antireflux surgery. The
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This article has an accompanying continuing medical education activity on page e39. Learning Objective—At the end of this activity, the successful learner will be able to identify and treat the common complications and side effects after antireflux therapy.
Conflicts of interest The author discloses no conflicts.