Surgery

Postoperative Problems and Complications after Fundoplication. Postoperative problems can include a delay in intestinal functioning causing bloating, gagging, and vomiting. They usually resolve in a few weeks. A 2003 study suggested, however, that 38% of patients develop such symptoms, and most occur more than year after the procedures. If symptoms persist or if they start weeks or months after surgery, particularly if vomiting is present, then surgical complications are likely. Complications include the following:

• An excessively wrapped fundus. This is fairly common and can cause difficulty swallowing (dysphagia) or experience gagging, gas, bloating, or inability to burp. (A follow-up procedure that dilates the esophagus using an inflated balloon may help correct dysphagia, although not 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 require a liquid diet, sometimes for weeks. This is a rare complication in most patients, but can be very high in children with neurologic abnormalities. Such children are, unfortunately, at very high risk for GERD in the first place.

Reasons for Treatment Failure. Long-term failure rates after fundoplication have been reported at 30% after 5 years to 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 repeat operations after open procedures in between 9% and 30% of cases and 13% after laparoscopy. (Repeat surgery usually has good results.)

Surgical Treatments Using Endoscopy

A number of treatments that make use of endoscopy are being used or investigated for increasing LES pressure and preventing reflux as well as for treating severe GERD and its complications.

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.