Fundoplication Complications and Management

Common Postoperative Complications

Postoperative dysphagia affects 5-43% of patients and represents the most frequent complication, occurring more commonly after total fundoplication compared to partial wraps 3
The American Academy of Pediatrics recommends that partial fundoplication should be strongly considered in patients with impaired esophageal peristalsis to avoid postoperative dysphagia while maintaining reflux control 4
Gas bloat syndrome occurs when patients cannot belch or vomit effectively due to the fundoplication wrap, with associated symptoms including flatulence, early satiety, and meteorism 3, 4

Children with neurologic impairment, esophageal atresia-tracheoesophageal fistula repair history, diffuse motility disorders, chronic pulmonary disease, and young infants have significantly higher failure rates 1, 2
For patients with esophageal atresia-tracheoesophageal fistula and severe refractory GERD, fundoplication may be necessary when chronic respiratory symptoms are thought secondary to reflux-related aspiration 6

Upper GI endoscopy, manometry, pH studies, and barium swallow should be performed first in patients with persistent dysphagia post-fundoplication to assess wrap integrity and understand the cause 3
The American Gastroenterological Association recommends that 24-hour multichannel intraluminal impedance-pH monitoring is the gold standard for confirming persistent or recurrent GERD after fundoplication 6

Careful patient selection is the most effective strategy for preventing fundoplication failure, with conditions such as cyclic vomiting, rumination, gastroparesis, and eosinophilic esophagitis must be carefully ruled out before surgery 1, 2, 7
If acid suppression with PPIs is ineffective preoperatively, the accuracy of the GERD diagnosis should be reassessed, as fundoplication may not produce optimal clinical results 1, 2, 7

The Society of American Gastrointestinal and Endoscopic Surgeons recommends that laparoscopic approach is preferred over open surgery, with overall in-hospital mortality of 0.14% 4
Closure of the diaphragmatic hiatus with non-absorbable sutures is essential to prevent wrap herniation, and the wrap should be tension-free to prevent postoperative complications 4

Endoscopic surveillance is recommended to monitor healing and detect potential complications, with periodic endoscopic surveillance advisable in patients with esophageal substitution or complex anatomy to detect potentially malignant lesions 4, 8