Review Article | Published:

Complications of Antireflux Surgery

The American Journal of Gastroenterologyvolume 113pages11371147 (2018) | Download Citation

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Abstract

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.

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Affiliations

  1. University of Colorado, Anschutz Medical Campus, Aurora, CO, USA

    • Rena Yadlapati MD, MSHS
  2. Northwestern University, Chicago, IL, USA

    • Eric S. Hungness MD
    •  & John E. Pandolfino MD, MSCI

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Conflict of interest

Guarantor of the article: Rena Yadlapati, MD, MSHS.

Specific author contributions: RY, ESH and JEP: literature review, drafting the manuscript and approving the final manuscript.

Financial support: RY and JEP supported by NIH R01 DK092217 (JEP).

Potential competing interests: RY: consultant for Ironwood, Medtronic and Diversatek; JEP: consultant for Crospon, Ironwood,Torax, Astra Zeneca, Takeda, Impleo, Medtronic and Sandhill; ESH: consultant for Baxter and Boston Scientific.

Corresponding author

Correspondence to Rena Yadlapati MD, MSHS.

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DOI

https://doi.org/10.1038/s41395-018-0115-7