Aortic injury during laparoscopic fundoplication: an underreported complication

Advances in video equipment, instrumentation, and laparoscopic skills have enabled the performance of an increasing variety of procedures using minimally invasive techniques. Additionally, the public is more aware of the benefits of laparoscopic surgery, including decreased postoperative pain and shortened recovery period. Surgical treatment of gastroesophageal reflux disease (GERD) is blossoming as a result. As with all surgical procedures, complications can occur. This case report describes a complication of laparoscopic fundoplication not previously reported. Also summarized is a review of all complications associated with minimal access fundoplication reported in the literature.

After appropriate evaluation for surgical treatment of GERD that revealed a nonspecific esophageal motility disorder, a 52-year-old female underwent laparoscopic Toupet fundoplication. During the procedure, a needle injury occurred to the aorta at the level of the hiatus. Despite exploration during the original procedure, which had been converted to laparotomy, and at two subsequent operations, the intermittent bleeding source was not found. The patient eventually died secondary to blood loss. The aortic injury was discovered postmortem.

A variety of intraoperative complications associated with laparoscopic fundoplication have been reported, including gastric, esophageal, and bowel perforations, cardiac tamponade, pneumothorax, celiac artery thrombosis, bleeding, and death. Although this is the first reported aortic injury during minimally invasive fundoplication not related to trocar placement, discussion with other surgeons indicates that this is not the only occurrence of this complication.