Laparoscopic management of a late gastric perforation post-fundoplication

Nissen fundoplication is a safe and effective procedure for gastroesophageal reflux. Gastric ulceration leading to perforation is an uncommon late complication with a mechanism of action that is poorly understood. A 40-year-old male presented 3 years following his fundoplication with a perforated ulcer in the upper body of the stomach. The patient admitted ibuprofen use leading up to the perforation. The perforation was successfully repaired via laparoscopy, with good postoperative outcome. Gastric ulcer perforation post-fundoplication is a rare late outcome. Gastric perforation may have been precipitated by the use of non-steroidal anti-inflammatory drugs (NSAIDs) in concert with the vascular mechanical changes caused by this procedure. A review of the literature reveals only a handful of accounts of gastric ulcers or perforations as a late outcome. Of note, many of these perforations occur in the upper stomach and in tandem with NSAID use.