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Iatrogenic thoracic migration of the stomach complicating laparoscopic nissen fundoplication
1Department of Upper Gastrointestinal and Minimally Invasive Surgery, Hull Royal Infirmary, Anlaby Road, Kingston Upon Hull, East Yorkshire, England HU3 2JZ.
Background:
Intrathoracic gastric herniation after laparoscopic Nissen fundoplication is an uncommon but potentially life-threatening complication that may present in the early or late postoperative period.
Methods:
A retrospective analysis was performed on all patients undergoing antireflux surgery from December 1991 to June 1999.
Results:
Nine cases of gastric herniation occurred after 511 operations (0.17%). Patients presented with the condition 4 days to 29 months after surgery. Eight of these nine patients (89%) had reported vomiting in the immediate postoperative period. Seven patients (78%) reported persistent odynophagia. A factor common to all patients was that posterior crural repair had not been performed.
Conclusions:
Measures should be undertaken to prevent postoperative vomiting after laparoscopic Nissen fundoplication. Posterior crural repair is essential after surgery in all cases.