CT of Nissen's fundoplication

Area of Science:

• Radiology
• Gastroenterology
• Surgical Anatomy

Background:

• Nissen fundoplication is a common surgical procedure for gastroesophageal reflux disease (GERD) and hiatal hernias.
• Postoperative anatomical assessment is crucial for evaluating surgical success and identifying complications.
• Computed tomography (CT) offers detailed cross-sectional imaging for anatomical evaluation.

Purpose of the Study:

• To describe the computed tomographic (CT) anatomy in patients following Nissen fundoplication.
• To identify anatomical variations and potential complications visualized by CT post-surgery.
• To assess the utility of CT in the follow-up of patients after Nissen fundoplication.

Main Methods:

• Retrospective analysis of CT scans from 40 patients (mean age 61) who underwent Nissen fundoplication.
• Patients had conditions including peptic esophagitis, refractory GERD, and hiatal hernia.
• CT examinations were performed using third-generation equipment with patients in the prone position after ingesting gastrovison and barium paste.

Main Results:

• CT demonstrated anatomical variations related to the Nissen fundoplication in 34 patients, often appearing as a soft tissue mass in the distal esophagus.
• Functional incompetence of the fundoplication was identified in three patients.
• A recurrent hiatal hernia was detected in one patient.

Conclusions:

• CT imaging is a valuable tool for assessing postoperative anatomy after Nissen fundoplication.
• CT can identify anatomical variations and complications such as fundoplication incompetence and recurrent hernias.
• CT serves as a complementary examination to endoscopy and functional tests in postoperative follow-up.