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Late gastric perforations after laparoscopic fundoplication
Kevin L Huguet1, Ronald A Hinder, Todd Berland
1Department of Surgery, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
Surgical Endoscopy
|May 8, 2007
Summary
Late gastric perforation is a rare complication after laparoscopic Nissen fundoplication. This study identified six cases in three patients, suggesting potential causes like medications or surgical materials.
Area of Science:
- Gastroenterology
- Surgical Complications
- Minimally Invasive Surgery
Background:
- Late complications following laparoscopic Nissen fundoplication are uncommon.
- Reported late complications include gastric herniation, port-site herniation, recurrent reflux, and fundoplication failure.
- Gastric perforation is a rare late complication, with only three prior cases documented, all linked to intrathoracic wrap herniation.
Observation:
- A retrospective review of 1,600 laparoscopic antireflux procedures was conducted.
- Six delayed gastric fundal perforations were identified in three patients between 1 and 72 months post-surgery.
- Perforations occurred on the anterior gastric wall, distant from the fundoplication stitches, and without significant peritoneal contamination.
Findings:
- The study identified six delayed gastric fundal perforations in three patients out of 1,600 procedures.
- These perforations occurred months to years after the initial laparoscopic antireflux surgery.
- The perforations were located on the anterior gastric wall, away from the surgical sutures.
Implications:
- Late gastric fundal perforations occurred in 0.2% of patients in this series.
- Potential causes include medications, gastric stasis, ischemia, or foreign bodies like sutures or pledgets.
- These findings highlight the importance of considering rare complications in the long-term follow-up of patients undergoing laparoscopic fundoplication.
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