Reoperation for recurrence and complications after nissen fundoplication

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  • FURUKITA Yoshihito
    Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Hospital
  • MORIMOTO Masami
    Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Hospital
  • GOTO Masakazu
    Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Hospital
  • YAMAMOTO Yota
    Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Hospital
  • TAKECHI Hirokazu
    Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Hospital
  • TANGOKU Akira
    Department of Thoracic, Endocrine Surgery and Oncology, Tokushima University Hospital

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Other Title
  • Nissen噴門形成術後の再発・合併症に対する再手術の経験
  • 臨床経験 Nissen噴門形成術後の再発・合併症に対する再手術の経験
  • リンショウ ケイケン Nissen フンモン ケイセイ ジュツゴ ノ サイハツ ・ ガッペイショウ ニ タイスル サイシュジュツ ノ ケイケン

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Abstract

There are few reports on reoperation often failure of Nissen fundoplication in Japan. Here, we have reported a case of successful reoperation by performing fundoplication in our department. Four patients had presented with giant esophageal hiatal hernia and had undergone laparoscopic Nissen fundoplicaion. However, 2 patients underwent hand-assisted laparoscopic surgery because of adhesion. An 83-year-old woman who had undergone open Nissen fundoplication in another hospital underwent reoperation. The patient was diagnosed with obstruction due to telescope phenomenon and recurrence of hernia. It was difficult to lyse the severe adhesion around the esophageal hiatus, but it was easy to eliminate the fundic wrap. We performed Toupet fundoplication and hernia repair in combination with upper endoscopy. We regarded elevation in abdominal pressure attributable to kyphosis and lack of skill in the primary operation as the recurrent factors. Reoperation for failure of fundoplication is very difficult technically, and it is important to determine the indication for reoperation by the severity of the disease and the patient's general condition.

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