Repair of Failed Nissen Fundoplication
Surgical procedures to correct reflux disease, also known as GERD, are usually highly successful. These procedures, which usually involve repair of a hiatal hernia, are undertaken when medications alone do not relieve troublesome and potentially dangerous symptoms. Sometimes, however, symptoms of GERD recur after surgery and the patient once again experiences heartburn, regurgitation, nausea or upper intestinal discomfort.
The most common procedure used to repair hiatal hernias is a Nissen fundoplication which involves wrapping stomach tissue from the upper part of the stomach, called the fundus, around the esophagus and stitching it in place. This is done in order to strengthen the valve between the esophagus and stomach and prevent stomach acid from invading the esophagus and throat. The most common reason for surgical failure is further herniation.
For a small percentage of patients, GERD symptoms may recur because the fundoplication has slipped out of place or become twisted. In a few cases, the reflux procedure may result in new symptoms because the fundoplication was wrapped excessively tightly. The most common of these symptoms is dysphagia, or difficulty swallowing. Other possible symptoms include bloating and flatulence.
For patients whose reflux procedures have failed, a secondary surgical repair is necessary to relieve symptoms and prevent further complications. Fortunately second surgical repairs are almost always able to be performed laparoscopically and have a very high rate of success.