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Updated: Aug 8, 2026

Technical Considerations and Approach to Redo Foregut Surgery
Published on: September 22, 2023
Complications after surgery for gastroesophageal reflux disease
Costas Bizekis1, Michael Kent, James Luketich
1Heart, Lung and Esophageal Surgery Institute, University of Pittsburgh Medical Center, PA 15213, USA.
Abstract:
Most complications after surgery for GERD can be avoided by experience and proper surgical technique. Often, what is termed a "slipped" or "twisted" wrap is one that was not properly constructed during the initial surgery. These technical errors can be avoided by complete mobilization of the stomach and esophagus, removal of the epigastric fat pad to identify esophageal shortening, and preservation of both vagus nerves. It is critical to avoid these errors, because an improperly constructed wrap will probably condemn the patient to significant dysphagia, recurrent reflux, and the need for reoperation. Should reoperation be required, the wrap should be completely dismantled so the technical error can be identified and a proper antireflux mechanism created.
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