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. 2009 Feb 4:3:1.
doi: 10.1186/1750-1164-3-1.

Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective

Tarun Singhal  1 , Santosh Balakrishnan, Abdulzahra Hussain, Starlene Grandy-Smith, Andrew Paix, Shamsi El-Hasani
Affiliations

Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective

Tarun Singhal et al. Ann Surg Innov Res. .

Abstract

Introduction: Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications at the earliest stage for effective management to minimise the morbidity and mortality.

Methods: 301 patients underwent laparoscopic treatment for GORD by a single consultant surgeon in our NHS Trust from September 1999. The data was prospectively collected and entered into a database. The data was retrospectively analysed for presentations for complications and their management.

Results: Surgery was completed laparoscopically in all patients, except in five, where the operation was technically difficult due to pre-existing conditions. The complications we encountered during surgery and follow-up period were major intra-operative bleeding (n = 1, 0.33%), severe post-operative nausea and vomiting (n = 1, 0.33%), wound infection (n = 3, 1%), port-site herniation (n = 1, 0.33%), wrap-migration (n = 2, 0.66%), wrap-ischaemia (n = 1, 0.33%), recurrent regurgitation (n = 4, 1.32%), recurrent heartburn (n = 29, 9.63%), tension pneumothorax (n = 2, 0.66%), surgical emphysema (n = 8, 2.66%), and port-site pain (n = 4, 1.33%).

Conclusion: Minimal access approach to treat GORD has presented with some specific and unique complications. It is important to recognise these complications at the earliest possible stage as some of these patients may present in an acute setting requiring emergency surgery. All members of the department, and not just the members of the specialised team, should be aware about these complications to minimise the morbidity and mortality.

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Figures

Figure 1
Figure 1
Patient distribution by symptoms (n = 301).
Figure 2
Figure 2
Findings of pH and manometric study.
See this image and copyright information in PMC

References

    1. Dent J, El-Serag HB, Wallander MA, Johansson S. Epidemilogy of Gastro-oesophageal reflux disease: a systematic review. Gut. 2005;54:710–717. doi: 10.1136/gut.2004.051821. - DOI - PMC - PubMed
    1. Turcotte S, Duranceau A. Gastroesophageal reflux and cancer. Thorac Surg Clin. 2005;15:341–352. doi: 10.1016/j.thorsurg.2005.03.003. - DOI - PubMed
    1. Malfertheiner P, Hallerback B. Clinical Manifestations and complications of gastroesophageal reflux disease (GERD) Int J Clin Pract. 2005;59:346–355. doi: 10.1111/j.1742-1241.2005.00370.x. - DOI - PubMed
    1. Mahon D, Rhodes M, Decadt B, Hindmarsh A, Lowndes R, Beckingham I, Koo B, Newcombe RG. Randomised clinical trial of Laparoscopic Nissen fundoplication compared with proton-pump inhibitors for treatment of chronic gastro-oesophageal reflux. Br J Surg. 2005;92:695–699. doi: 10.1002/bjs.4934. - DOI - PubMed
    1. Kamolz T, Granderath FA, Schwieger UM, Pointer R. Laparoscopic Nissen Fundoplication in patients with nonerosive reflux disease. Long-term quality – of – life assessment and surgical outcome. Surg Endosc. 2005;19:494–500. doi: 10.1007/s00464-003-9267-6. - DOI - PubMed

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