What are some of the changes that can result in failure of antireflux barrier?

What are some of the changes that can result in failure of antireflux barrier?

Conclusions Failure of the crural closure and malformation of the wrap are the main reasons for failure of antireflux procedures. Use of proper surgical techniques including meticulous closure of the crura and appropriate construction and fixation of the wrap at the first operation will help prevent recurrence.

What happens if a Nissen fundoplication come undone?

Complications. Complications include “gas bloat syndrome”, dysphagia (trouble swallowing), dumping syndrome, excessive scarring, vagus nerve injury and, rarely, achalasia. The fundoplication can also come undone over time in about 5–10% of cases, leading to recurrence of symptoms.

What are the complications of fundoplication?

Possible complications associated with laparoscopic Nissen fundoplication include:

• Bleeding at the surgical site.
• Difficulty swallowing (dysphagia) because your stomach is wrapped too high on your esophagus or wrapped too tightly.
• Difficulty belching.
• Infection in your abdomen (peritonitis)

Can you redo a Nissen fundoplication?

In summary, carefully selected patients who have recurrent or persistent problems after fundoplication can safely undergo redo fundoplication with good results. In experienced hands, most patients can be approached laparoscopically.

Can a Nissen fundoplication failure?

Failure following Nissen fundoplication for paraesophageal hernia also ranges from 7%–33%, depending on whether failure is defined symptomatically or anatomically. In select cases, fundoplication failure requires revisional fundoplication (redo).

What happens if fundoplication is too tight?

A tight Nissen fundoplication refers to obstruction of the distal esophagus due to a fundoplication wrap that is too tight or too long (more than 2 cm) or a crural stenosis (8,13–15). Symptoms include dysphagia, bloating, and regurgitation of undigested food and persist several weeks after the procedure.

What is a slipped Nissen fundoplication?

Slipped Nissen fundoplication is the axial movement of the esophagus back into the chest due to poor mobilization. Such axial movement drags the GEJ and upper part of the stomach through the fundoplication, hence the term slipped fundoplication.

What are the possible complications of a Nissen fundoplication?

Case histories of 25 patients are reported in whom complications after a Nissen fundoplication were sufficiently severe to require reoperation. Patients were classified by complications as having postoperative dysphagia (14), recurrent reflux (seven), “gas bloat” syndrome (two), and paraesophageal hernia (two).

What are the types of failed fundoplications?

Failed fundoplications are classified into six types: tight Nissen, incompetent repair, disruption of the wrap, stomach slippage above the diaphragm, slipped Nissen, and transdiaphragmatic wrap herniation.

What is the success rate of laparoscopic Nissen fundoplication?

Laparoscopic Nissen fundoplication is an effective antireflux procedure with a long-term success rate of over 90% ( 2, 8, 13 ). Persistent or recurrent symptoms of reflux and/or persistent postoperative dysphagia are the most common indicators of fundoplication failure ( 13 ).

What are the complications of fundoplication wrap failure?

Complications 1 Tight Nissen. 2 Patulous or Incompetent Repair. 3 Disruption of the Wrap (Hinder Type I) Disruption of the fundoplication wrap (Hinder type I failure) involves partial or complete breakdown of the wrap and, in most cases, a recurrence