Definitive surgical therapy for incapacitating "gas-bloat" syndrome

Posterior gastropexy appears to be the treatment of choice in the occasional patient with persistent debilitating post-fundoplication syndrome. This syndrome occurs to this extent only rarely (less than 1%) and chronic small-bowel obstruction or dysfunction may be a predisposing factor. We prefer the posterior gastropexy of Hill in cases of reflux esophagitis uncomplicated by Barretts mucosa, stricture, or esophageal shortening. The authors especially caution against the use of fundoplication as an incidental procedure for anatomic repair of an asymptomatic hiatus hernia or in patients with a history of small bowel obstruction.