Abstract
Abstract:Gastroesophageal reflux disease is a common condition affecting many individuals in the Western world. Most patients are managed successfully with acid suppression, while others may require more invasive interventions. The majority of patients undergoing antireflux surgery will have favorable outcomes. A small percentage, however, will be considered surgical failures and will either present with new or recurrent symptoms, or develop postoperative complications. These include, but are not limited to, symptoms such as dysphagia, gas-bloat syndrome, and bowel dysfunctions that may significantly impair the patient’s health and quality of life. As the number of antireflux procedures for this condition continue to increase, the number of complications is also likely to become more prevalent. The primary care physician will be challenged to recognize them and initiate appropriate management. In this review, we address the more common gastrointestinal complications of laparoscopic Nissen fundoplication and offer general guidelines in their diagnosis and management.
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References
References1. Cowgill SM, Gillman R, Kraemer E, et al. Ten-year follow up after laparoscopic Nissen fundoplication for gastroesophageal reflux disease. Am Surg 2007;73:748–753.CowgillSM]]GillmanR]]KraemerE&etal;Ten-year follow up after laparoscopic Nissen fundoplication for gastroesophageal reflux disease.Am Surg200773748-7532. Kahrilas PJ, Shaheen NJ, Vaezi MF; American Gastroenterological Association. American Gastroenterological Association Medical Position Statemtent on the management of gastroesophageal reflux disease. Gastroenterology 2008;135:1383–1391.KahrilasPJ]]ShaheenNJ]]VaeziMFAmerican Gastroenterological AssociationAmerican Gastroenterological Association Medical Position Statemtent on the management of gastroesophageal reflux disease.Gastroenterology20081351383-13913. Ireland AC, Holloway RH, Toouli J, et al. Mechanisms underlying the antireflux action of fundoplication. Gut 1993;34:303–308.IrelandAC]]HollowayRH]]ToouliJ&etal;Mechanisms underlying the antireflux action of fundoplication.Gut199334303-3084. Spechler SJ, Lee E, Ahnen D, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial. JAMA 2001;285:2331–2338.SpechlerSJ]]LeeE]]AhnenD&etal;Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: follow-up of a randomized controlled trial.JAMA20012852331-23385. Perdikis G, Hinder RA, Lund RJ, et al. Laparoscopic Nissen fundoplication: where do we stand? Surg Laparosc Endosc 1997;7:17–21.PerdikisG]]HinderRA]]LundRJ&etal;Laparoscopic Nissen fundoplication: where do we stand?Surg Laparosc Endosc1997717-216. Oelschlager BK, Quiroga E, Parra JD, et al. Long-term outcomes after laparoscopic antireflux surgery. Am J Gastroenerol 2008;103:280–287.OelschlagerBK]]QuirogaE]]ParraJD&etal;Long-term outcomes after laparoscopic antireflux surgery.Am J Gastroenerol2008103280-2877. Le Blanc-Louvry I, Köning E, Zalar A, et al. Severe dysphagia after laparoscopic fundoplication: usefulness of barium meal examination to identify causes other than tight fundoplication—a prospective study. Surgery 2000;128:392–398.Le Blanc-LouvryI]]KöningE]]ZalarA&etal;Severe dysphagia after laparoscopic fundoplication: usefulness of barium meal examination to identify causes other than tight fundoplication—a prospective study.Surgery2000128392-3988. Papasavas P. Functional problems following esophageal surgery. Surg Clin North Am 2005;85:525–538.PapasavasPFunctional problems following esophageal surgery.Surg Clin North Am200585525-5389. Galvani C, Fisichella PM, Gorodner MV, et al. Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease: role of esophageal functions tests. Arch Surg 2003;138:514–518.GalvaniC]]FisichellaPM]]GorodnerMV&etal;Symptoms are a poor indicator of reflux status after fundoplication for gastroesophageal reflux disease: role of esophageal functions tests.Arch Surg2003138514-51810. Stark ME, Devault KR. Complications following fundoplication. Tech Gastrointest Endosc 2006;8:40–53.StarkME]]DevaultKRComplications following fundoplication.Tech Gastrointest Endosc2006840-5311. Polk HC Jr. Fundoplication for reflux esophagitis: misadventures with the operation of choice. Ann Surg 1976;183:645–652.PolkHCJrFundoplication for reflux esophagitis: misadventures with the operation of choice.Ann Surg1976183645-65212. Low DE. Management of the problem patient after antireflux surgery. Gastroenterol Clin North Am 1994;23:371–389.LowDEManagement of the problem patient after antireflux surgery.Gastroenterol Clin North Am199423371-38913. Hill LD. Incarcerated paraesophageal hernia: a surgical emergency. Am J Surg 1973;126:286–291.HillLDIncarcerated paraesophageal hernia: a surgical emergency.Am J Surg1973126286-29114. Stylopoulos N, Bunker CJ, Rattner DW. Development of achalasia secondary to laparoscopic Nissen fundoplication. J Gastrointest Surg 2002;6:368–378.StylopoulosN]]BunkerCJ]]RattnerDWDevelopment of achalasia secondary to laparoscopic Nissen fundoplication.J Gastrointest Surg20026368-37815. Granderath FA, Kamolz T, Granderath UM, et al. Gas-related symptoms after laparoscopic 360 degrees Nissen or 270 degrees Toupet fundoplication in gastroesophageal reflux disease patients with aerophagia as comorbidity. Dig Liver Dis 2007;39:312–318.GranderathFA]]KamolzT]]GranderathUM&etal;Gas-related symptoms after laparoscopic 360 degrees Nissen or 270 degrees Toupet fundoplication in gastroesophageal reflux disease patients with aerophagia as comorbidity.Dig Liver Dis200739312-31816. Hunter RJ, Metz DC, Morris JB, et al. Gastroparesis: a potential pitfall of laparoscopic Nissen fundoplication. Am J Gastroenterol 1996;91:2617–2618.HunterRJ]]MetzDC]]MorrisJB&etal;Gastroparesis: a potential pitfall of laparoscopic Nissen fundoplication.Am J Gastroenterol1996912617-261817. Anvari M, Jamieson GG. Surgical applications of the function of the pylorus. Surg Annu 1992;24:181–194.AnvariM]]JamiesonGGSurgical applications of the function of the pylorus.Surg Annu199224181-19418. Lundell LR, Myers JC, Jamieson GG. Delayed gastric emptying and its relationship to symptoms of “gas-float” after antireflux surgery. Eur J Surg 1994;160:161–166.LundellLR]]MyersJC]]JamiesonGGDelayed gastric emptying and its relationship to symptoms of “gas-float” after antireflux surgery.Eur J Surg1994160161-16619. Kozarek RA, Low DE, Raltz SL. Complications associated with laparoscopic anti-reflux surgery: one multispecialty clinic’s experience. Gastrointest Endosc 1997;46:527–531.KozarekRA]]LowDE]]RaltzSLComplications associated with laparoscopic anti-reflux surgery: one multispecialty clinic’s experience.Gastrointest Endosc199746527-53120. Swanstrom L, Wayne R. Spectrum of gastrointestinal symptoms after laparoscopic fundoplication. Am J Surg 1994;167:538–541.SwanstromL]]WayneRSpectrum of gastrointestinal symptoms after laparoscopic fundoplication.Am J Surg1994167538-54121. Nastaskin I, Mehdikhani E, Conklin J, et al. Studying the overlap be-tween IBS and GERD: a systematic review of the literature. Dig Dis Sci 2006;51:2113–2120.NastaskinI]]MehdikhaniE]]ConklinJ&etal;Studying the overlap be-tween IBS and GERD: a systematic review of the literature.Dig Dis Sci2006512113-212022. Klaus A, Hinder RA, DeVault KR, et al. Bowel dysfunction after laparoscopic antireflux surgery: incidence, severity, and clinical course. Am J Med 2003;114:6–9.KlausA]]HinderRA]]DeVaultKR&etal;Bowel dysfunction after laparoscopic antireflux surgery: incidence, severity, and clinical course.Am J Med20031146-923. Lundell L. Complications after anti-reflux surgery. Best Pract Res Clin Gastroenterol 2004;18:935–945.LundellLComplications after anti-reflux surgery.Best Pract Res Clin Gastroenterol200418935-945
