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GERD Surgery - Fundoplication Risks and Possible Complications

When successful, fundoplication surgery eliminates the need for long-term medication. If you are trying to decide between surgery and medication for treatment, weigh the cost, risks, and possible complications of the surgery against the cost, inconvenience and potential side effects associated with long-term medication therapy.

For the most part, laparoscopic fundoplication appears to be safe and reasonably effective in patients of all ages, but, as with any surgery, there are some risks and possible complications.

General risks and complications relating to surgery

With any invasive surgery involving general anaesthetic there are risks:

  • risks associated with anesthesia - about 1 in 500 people (0.2%) who have this surgery die from anesthesia or complications from the surgery.*
  • pain
  • bleeding
  • infection in the surgical site
  • scarring
  • developing a hernia in the scar
  • blood clots

Risks and complications specific to fundoplication surgery

Postoperative problems can include a delay in intestinal functioning causing bloating, gagging, and vomiting. These side effects usually resolve within a few weeks. A 2003 study suggested, however, that 38% of patients develop such symptoms, and most occur more than a year after the procedures. If symptoms persist particularly if vomiting is present, then surgical complications are likely (they may even start weeks or months after surgery). For some people, the side effects of surgery – bloating caused by gas buildup, swallowing problems, pain at the surgical site – are just as bothersome as GERD symptoms. The fundoplication procedure cannot be reversed, and in some cases it may not be possible to relieve the symptoms of these complications, even with a second surgery.These complications can include:

  • an excessively wrapped fundus. This is fairly common and can cause difficulty swallowing (dysphagia), as well as gagging, gas, bloating, or an inability to burp. (A follow-up procedure that dilates the esophagus using an inflated balloon often helps correct dysphagia)
  • The esophagus sliding out of the wrapped portion of the stomach so that the valve (lower esophageal sphincter) is no longer supported.
  • bowel obstruction
  • muscle spasms after swallowing food (this can be very painful, and patients may require a liquid diet).

Complications specific to laparoscopic surgery:

  • damage to nearby organs
  • developing a hernia near one of the cuts
  • surgical emphysema
  • respiratory complications, such as a collapsed lung.

Complications specific to Nissen fundoplication

  • difficulty swallowing for the first few months
  • air in the chest cavity
  • tear of the stitches used for the wrap
  • damage to the liver
  • continued difficulty swallowing
  • unresolved reflux symptoms
  • weight loss
  • abdominal discomfort
  • diarrhoea

The experience and skill of the surgeon can substantially reduce complication risks. Some studies have reported that repeat operations after open procedures occur in 9 - 30% of cases and 13% after laparoscopy

(see video of laparoscopic Nissen fundoplication)

* Spechler SJ, et al. (2001). Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease: Follow-up of a randomized controlled trial. JAMA, 285(18): 2331–2338.

GERD Surgery- Fundoplication - References

By Mortin - Copyright 2010
Last modification 05/02/2010