Postoperative Problems and Complications after Fundoplication. Problems after surgery can include a delay in intestinal functioning, causing bloating, gagging, and vomiting. These side effects usually go away in a few weeks. If symptoms last or start weeks or months after surgery, particularly if there is vomiting, surgical complications are likely. Complications include:
- An excessively wrapped fundus. This is fairly common and can cause difficulty swallowing (dysphagia), as well as gagging, gas, bloating, or an inability to burp. (A follow-up procedure that dilates the esophagus using an inflated balloon may help correct dysphagia, although it cannot treat other symptoms.)
- Bowel obstruction
- Wound infection
- Injury to nearby organs
- Respiratory complications, such as a collapsed lung. These are uncommon, particularly with laparoscopic fundoplication.
- Muscle spasms after swallowing food. This can cause intense pain, and patients may need to eat a liquid diet, sometimes for weeks. This is a rare complication in most patients, but the risk can be very high in children with brain and nervous system (neurologic) abnormalities. Such children are already at very high risk for GERD.
Reasons for Treatment Failure. Long-term failure rates after fundoplication are 30% after 5 years and 63% after 10 years. Hiatal herniation is the most common reason for surgical failure and the need for a repeat fundoplication. Other common reasons for reoperation include breakdown, slippage, and excessive tightness of the wrap. Surgeon experience can lessen complication risks. Some studies have reported that 3 - 6% of patients need repeat operations, usually because of continuing reflux symptoms and swallowing difficulty (dysphagia). Repeat surgery usually has good success, significantly reducing symptoms in about 70% of patients. However, these surgeries can also lead to greater complications, such as injury to the liver or spleen.
Surgical Treatments Using Endoscopy
A number of endoscopic treatments are being used or investigated for increasing LES pressure and preventing reflux, as well as for treating severe GERD and its complications. Researchers find that endoscopic therapies for GERD may relieve symptoms and reduce the need for antireflux medications, although they are not as effective as laparoscopic fundoplication. Endoscopic procedures are also being done along with fundoplication.
Transoral Flexible Endoscopic Suturing. Transoral flexible endoscopic suturing (sometimes referred to as Bard's procedure) uses a tiny device at the end of the endoscope that acts like a miniature sewing machine. It places stitches in two locations near the LES, which are then tied to tighten the valve and increase pressure. There is no incision and no need for general anesthesia.
Radiofrequency. Radiofrequency energy generated from the tip of a needle (sometimes called the Stretta procedure) heats and destroys tissue in problem spots in the LES. Either the resulting scar tissue strengthens the muscle, or the heat kills the nerves that caused the malfunction. Patients may experience some chest or stomach pain afterwards. Few serious side effects have been reported, although there have been reports of perforation, hemorrhage, and even death.
Dilation Procedures. Strictures (abnormally narrowed regions) may need to be dilated (opened) with endoscopy. Dilation may be performed by inflating a balloon in the passageway. About 30% of patients who need this procedure require a series of dilation treatments over a long period of time to fully open the passageway. Long-term use of PPIs may reduce the duration of treatments.
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Review Date: 07/11/2010
Reviewed By: Reviewed by: Harvey Simon, MD, Editor-in-Chief, Associate Professor
of Medicine, Harvard Medical School; Physician, Massachusetts
General Hospital. Also reviewed by David Zieve, MD, MHA, Medical
Director, A.D.A.M., Inc.
A.D.A.M., Inc. is accredited by URAC, also known as the American Accreditation HealthCare Commission (www.urac.org)
