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Complications of Antireflux Surgery

Yadlapati, Rena, MD, MSHS1; Hungness, Eric S., MD2; Pandolfino, John E., MD, MSCI2

American Journal of Gastroenterology: August 2018 - Volume 113 - Issue 8 - p 1137–1147
doi: 10.1038/s41395-018-0115-7

Antireflux surgery anatomically restores the antireflux barrier and is a therapeutic option for proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease or PPI intolerance. Laparoscopic fundoplication is the standard antireflux surgery, though its popularity has declined due to concerns regarding wrap durability and adverse events. As the esophagogastric junction is an anatomically complex and dynamic area subject to mechanical stress, wraps are susceptible to disruption, herniation or slippage. Additionally, recreating an antireflux barrier to balance bidirectional bolus flow is challenging, and wraps may be too tight or too loose. Given these complexities it is not surprising that post-fundoplication symptoms and complications are common. Perioperative mortality rates range from 0.1 to 0.2% and prolonged structural complications occur in up to 30% of cases. Upper gastrointestinal endoscopy with a comprehensive retroflexed examination of the fundoplication and barium esophagram are the primary tests to assess for structural complications. Management hinges on differentiating complications that can be managed with medical and lifestyle optimization versus those that require surgical revision. Reoperation is best reserved for severe structural abnormalities and troublesome symptoms despite medical and endoscopic therapy given its increased morbidity and mortality. Though further data are needed, magnetic sphincter augmentation may be a safer alternative to fundoplication.

1University of Colorado, Anschutz Medical Campus, Aurora, CO, USA. 2Northwestern University, Chicago, IL, USA.

Correspondence: R.Y. (email:

Received 3 February 2018; accepted 11 April 2018; Published online 14 June 2018

see related CME on page 1117

© The American College of Gastroenterology 2018. All Rights Reserved.
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