Unusual complication after laparoscopic Nissen fundoplication

We describe a rare complication of Laparoscopic Nissen Fundoplication in the presence of a Gastric greater curvature Plication (LNFGP). An overweight 64-year-old woman was admitted for severe abdominal pain, dysphagia and fever 2 weeks after a Nissen fundoplication. She had pneumoperitoneum on scanner. At laparoscopy, we found a generalized peritonitis secondary to a perforated Nissen wrap in the presence of a gastric greater curvature plication. Gastric bypass and sleeve gastrectomy can be irrelevant in case of moderately and severely obese patients with gastroesophageal reflux disease. Four studies have investigated the risks and rewards of the LNFGP as an alternative. Only one case of leakage has been reported. We present another severe complication: the pylorus stenosis caused by a plication performed too close to the pylorus, causing gastric dilatation in the presence of the wrap, leading to wrap perforation.