Síntomas y complicaciones posfunduplicatura: abordaje diagnóstico y tratamiento

Abstract

Laparoscopic Nissen fundoplication is currently considered the surgical treatment of choice for gastroesophageal reflux disease (GERD) and its long-term effectiveness is above 90%. Adequate patient selection and the experience of the surgeon are among the predictive factors of good clinical response. However, there can be new, persistent, and recurrent symptoms after the antireflux procedure in up to 30% of the cases. There are numerous causes, but in general, they are due to one or more anatomic abnormalities and esophageal and gastric function alterations. When there are persistent symptoms after the surgical procedure, the surgery should be described as "failed". In the case of a patient that initially manifests symptom control, but the symptoms then reappear, the term "dysfunction" could be used. When symptoms worsen, or when symptoms or clinical situations appear that did not exist before the surgery, this should be considered a "complication". Postoperative dysphagia and dyspeptic symptoms are very frequent and require an integrated approach to determine the best possible treatment. This review details the pathophysiologic aspects, diagnostic approach, and treatment of the symptoms and complications after fundoplication for the management of GERD.

Surgical Therapy of Esophagus Reflux Disease

“…Early complications include post-surgical dysphagia, pneumothorax and emphysema, perforation of esophagus and stomach. The most frequently occurring late complications include gas-bloat syndrome (10).…”

Complications of Antireflux Surgery

“…22 The two most common partial laparoscopic fundoplication techniques include a 270-degree posterior (Toupet) fundoplication sutured to the crura and esophagus which creates a flap valve while leaving the anterior esophagus exposed to allow for radial expansion [Figure 1b] and a 180-degree anterior (Dor) fundoplication sutured to the esophagus and right crus which restores the angle of His and creates a flap valve mechanism [Figure 1c]. 22, 23…”

“…Persistent dysphagia due to fundoplication related stenosis without herniation may occur in 10% of cases 33 and is secondary to a very tight or long fundoplication [Figure 4]. 23, 24, 29 This is usually the result of poor positioning of the wrap or construction of a tense fundoplication wrap even when a bougie is used during the fundoplication component of the operation. 27 Other structural sources of persistent dysphagia include excessive angulation at the esophagogastric junction and intraluminal penetration of prosthetic surgical material.…”

“…27 Other structural sources of persistent dysphagia include excessive angulation at the esophagogastric junction and intraluminal penetration of prosthetic surgical material. 23…”

“…In addition, patients may develop aerophagia and supragastric belching in an attempt to palliate these uncomfortable symptoms. 23, 24, 29 There is a paucity of data to guide the management of gas-bloat syndrome, and generally lifestyle modifications are recommended. These include avoidance of gas-producing foods and carbonated beverages, eating slowly to prevent aerophagia, tobacco cessation, and using gas-reducing agents (i.e., simethicone) and prokinetic drugs.…”