Figure 9 - Mechanisms of fundoplication failure.

a: Total disruption of the fundoplication with herniation of the fundus into the mediastinum. b: Herniation of the fundus into the chest through the fundoplication—a slipped Nissen. This complication is most likely caused by an unrecognized short esophagus. c: The fundus has been wrapped around the body of the stomach—a technical error. d: Total herniation of the fundoplication into the chest.