Pitfalls and complications of antireflux surgery. Nissen and Collis-Nissen techniques

The outcome of total fundoplication surgery for GER disease is unsatisfactory in 15% of patients. The likelihood of an unsuccessful outcome can be reduced by careful patient selection, which includes making an accurate diagnosis, and by choosing an operation that is tailored to the patient's physiology. Intraoperative and acute postoperative complications fortunately are rare and can be avoided through the use of meticulous surgical techniques. Late complications, including dysphagia, recurrent reflux symptoms, and delayed gastric emptying, are common and have a rate of reoperation of up to 10%; a systematic evaluation usually discloses their underlying causes. A slipped fundoplication wrap, an excessively tight wrap, a paraesophageal hiatal hernia, and severe recurrent symptoms are common indications for reoperation.