Intrathoracic Migration of the Wrap After Laparoscopic Nissen  Fundoplication

Hainaux, Bernard; Sattari, Azadeh; Coppens, Emmanuel; Sadeghi, Niloufar; Cadière, Guy-Bernard

doi:10.2214/ajr.178.4.1780859

Cited by 37 publications

(23 citation statements)

References 9 publications

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“…Postoperative herniation of the fundoplication into the chest is not an uncommon occurrence after laparoscopic fundoplication and has been reported to occur in as many as 30% of cases. 40 Most herniations are small and asymptomatic. Yet the presence of the wrap in the chest has been reported as one of the major etiologic factor behind the occurrence of perforations and GBF.…”

Section: Discussionmentioning

confidence: 99%

Gastro-bronchial Fistula After Laparoscopic Nissen Fundoplication

Faraj

Khalifeh²,

Soweid³

et al. 2007

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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Gastro-bronchial fistula (GBF) is an unusual complication of Nissen fundoplication, particularly when performed via a transabdominal approach. The mechanism of such fistula is thought to be related to a previously untreated ulcer in the mucosa of the wall of the gastric wrap or to a subclinical injury to the gastric wall during the process of division of the short gastric vessels and gastric mobilization. This process is greatly aided by herniation of the wrap into the chest in the postoperative period, placing the stomach in intimate contact with the bronchial tree. The diagnosis of GBF is often difficult to establish and requires a high index of suspicion. Most investigative studies tend to be unrevealing. Historically, an upper gastrointestinal series was the recommended study of choice in the literature. Newer reports, however, highlight the value and importance of upper endoscopy as a diagnostic tool in this condition. The majority of GBF were reported in the era of transthoracic Nissen fundoplication. The incidence of this complication seems to have markedly decreased after the widespread adoption of the transabdominal approach to the treatment of GERD. We are reporting the second case in the literature of a GBF developing after a laparoscopic Nissen fundoplication in a 28-year-old male patient. This case report should serve to increase awareness of this uncommon complication that should be considered in the differential diagnosis of patients with recurrent pneumonia or refractory hemoptysis after major upper gastrointestinal surgical procedures.

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Section: Discussionmentioning

confidence: 99%

Gastro-bronchial Fistula After Laparoscopic Nissen Fundoplication

Faraj

Khalifeh²,

Soweid³

et al. 2007

Surgical Laparoscopy, Endoscopy &Amp; Percutaneous Techniques

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“…completely below the diaphragm; fundoplication partly herniated above the diaphragm but the GOJ remains below the diaphragm (Type I migration) ( Figures 3 and 4); fundoplication completely herniated above the diaphragm with the GOJ at or above the level of the diaphragm (Type II migration) ( Figure 5)] [14].…”

Section: Structured Report For Contrast Study Reviewmentioning

confidence: 99%

“…However, there is very little in the literature addressing the quality and accuracy of post-operative contrast swallows. One prior publication [14] found that agreement between two radiologists in differentiating partial (Type I) and total (Type II) wrap migrations was good (k50.84), but no mention was made of the accuracy of diagnosis nor of the interobserver reliability within and between upper gastrointestinal surgeons and radiologists. The aim of this study was to determine the accuracy and interobserver reliability of surgeons and radiologists in interpreting post-operative contrast studies following laparoscopic fundoplication.…”

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confidence: 99%

Post-fundoplication contrast studies: is there room for improvement?

Raeside

Madigan

Myers

et al. 2012

BJR

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Objective: Since the mid-1990s, laparoscopic fundoplication for gastro-oesophageal reflux disease has become the surgical procedure of choice. Several surgical groups perform routine post-operative contrast studies to exclude any (asymptomatic) anatomical abnormality and to expedite discharge from hospital. The purpose of this study was to determine the accuracy and interobserver reliability for surgeons and radiologists in contrast study interpretation. Methods: 11 surgeons and 13 radiologists (all blinded to outcome) retrospectively reviewed the contrast studies of 20 patients who had undergone a laparoscopic fundoplication. Each observer reported on fundal wrap position, leak or extravasation of contrast and contrast hold-up at the gastro-oesophageal junction (on a scale of 0-4). A k coefficient was used to evaluate interobserver reliability. Results: Surgeons were more accurate than radiologists in identifying normal studies (specificity591.6% vs 78.9%), whereas both groups had similar accuracy in identifying abnormal studies (sensitivity582.3% vs 85.2%). There was higher agreement amongst surgeons than amongst radiologists when determining wrap position (k50.65 vs 0.54). Both groups had low agreement when classifying a wrap migration as partial or total (k50.33 vs 0.06). Radiologists were more likely to interpret the position of the wrap as abnormal (relative risk51.25) while surgeons reported a greater degree of hold-up of contrast at the gastro-oesophageal junction (mean score51.17 vs 0.86). Conclusion: Radiologists would benefit from more information about the technical details of laparoscopic anti-reflux surgery. Standardised protocols for performing postfundoplication contrast studies are needed.

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“…Im Anschluss an die Öso-phagoskopie traten erstmalig Schmerzen auf, welche nach der Bougierung an Intensität zunahmen und mit Dyspnoe einhergingen. Die vorliegenden Befunde lassen folgende Schlüsse zu: Während direkt postoperativ eine zu enge Manschette die Schluckstörung bedingte, könnte durch Erbrechen eine neu aufgetretene paraösophageale Hernie die Dysphagie verstärkt haben, ohne jedoch durch Schmerzen symptomatisch zu werden [4]. Die durchgeführte Ösophagoskopie erwies sich in der Diagnosefindung als unzuverlässig, da endoskopische Befunde schwierig zu interpretieren sind [5].…”

Section: Diskussionunclassified

Dysphagie und akute Dyspnoe nach laparoskopischer Fundoplikatio

Wieckenberg

Schahmirzadi

Fleischer

2007

Chirurg

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Intrathoracic gastric herniation after laparoscopic antireflux surgery is a rare but well known phenomenon. It may occur during the early and late postoperative period. We report on a patient with early onset of dysphagia after surgery due to a tight wrap. Subsequent vomiting and dysphagia increased due to a gastric herniation. After gastroscopy and bougienage, tension pneumothorax developed. The context and relationships are illustrated and discussed referring to the current literature.

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Intrathoracic Migration of the Wrap After Laparoscopic Nissen Fundoplication

Cited by 37 publications

References 9 publications

Gastro-bronchial Fistula After Laparoscopic Nissen Fundoplication

Gastro-bronchial Fistula After Laparoscopic Nissen Fundoplication

Post-fundoplication contrast studies: is there room for improvement?

Dysphagie und akute Dyspnoe nach laparoskopischer Fundoplikatio

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