Unusual complication after laparoscopic Nissen fundoplication

Area of Science:

• Gastroenterology
• Surgical Innovation
• Bariatric Surgery

Background:

• Laparoscopic Nissen Fundoplication with Gastric Plication (LNFGP) is explored as an alternative for obese patients with gastroesophageal reflux disease.
• While generally safe, rare complications require careful consideration.

Observation:

• A 64-year-old woman presented with severe abdominal pain, dysphagia, and fever two weeks post-LNFGP.
• Imaging revealed pneumoperitoneum, confirmed during laparoscopy as generalized peritonitis secondary to a perforated Nissen wrap.

Findings:

• The perforation occurred in the context of a gastric greater curvature plication.
• A critical finding was pylorus stenosis, caused by plication too close to the pylorus, leading to gastric dilation and subsequent wrap perforation.

Implications:

• This case underscores the potential for severe complications, including wrap perforation, with LNFGP.
• Pyloric stenosis is identified as a significant risk factor, necessitating precise surgical technique to avoid adverse outcomes.