Nissen fundoplication and gastrointestinal-related complications: a guide for the primary care physician

Gastroesophageal reflux disease is a common condition affecting many individuals in the Western world. Most patients are managed successfully with acid suppression, while others may require more invasive interventions. The majority of patients undergoing antireflux surgery will have favorable outcomes. A small percentage, however, will be considered surgical failures and will either present with new or recurrent symptoms, or develop postoperative complications. These include, but are not limited to, symptoms such as dysphagia, gas-bloat syndrome, and bowel dysfunctions that may significantly impair the patient's health and quality of life. As the number of antireflux procedures for this condition continue to increase, the number of complications is also likely to become more prevalent. The primary care physician will be challenged to recognize them and initiate appropriate management. In this review, we address the more common gastrointestinal complications of laparoscopic Nissen fundoplication and offer general guidelines in their diagnosis and management.