weekly_question 18/4/2021

[Admin]

A two year old boy undergoes Nissen fundoplication for severe gastroesophageal reflux disease. What is the most common complication associated with Nissen fundoplication?

A Surgical site infection

B Dysphagia

C Retching

D Feeding intolerance

E Recurrent GERD

[Admin]

I think E
so it should be assossiated with selective vagotomy

correct

Immediate complications following Nissen fundoplication are not too common. Surgical site infections occur in 7% of patients undergoing both gastrostomy tube placement and Nissen fundoplication according to Peds NSQIP data. Esophageal or gastric perforations are rare and present with fever, tachycardia, and other signs of sepsis.

Long-term complications associated with Nissen fundoplication include gas bloat syndrome, dysphagia, and recurrent GERD. Gas bloat syndrome is poorly defined and often attributed to any pain or discomfort following Nissen fundoplication. Symptoms include crampy abdominal pain and gastric distention. These symptoms can often be managed by slowing the rate of feedings or other manipulations of the feeding regimen.

Dysphagia commonly occurs right after surgery and improves over time. Some patients may require esophageal dilation in the immediate postoperative period. Some studies report that such dilations are required in up to 12% of patients. Dilation has shown to increase the risk of recurrent GERD.

The overall rate of recurrent GERD is difficult to define. One study showed that over 70% of patients were prescribed antireflux medications within one year of Nissen fundoplciation, thus making recurrent reflux as the most common complication following Nissen fundoplication. Recurrent GERD is also the most common complication requiring revisional surgery. Multiple risk factors increase the risk of recurrence and include young age at the time of fundoplication, neurologic impairment, history of esophageal atresia, presence of delayed gastric emptying, need for esophageal dilation, and circumferential dissection of the esophagus.

@Nora Atiah, do you routinely do selective vagotomy with fundo cases ?

[Sharon]

B

[Admin]

think again my dear

[Nora Atiah]

I think E
so it should be assossiated with selective vagotomy

[Dr Ammar]

C

[Admin]

I think E
so it should be assossiated with selective vagotomy

correct

Immediate complications following Nissen fundoplication are not too common. Surgical site infections occur in 7% of patients undergoing both gastrostomy tube placement and Nissen fundoplication according to Peds NSQIP data. Esophageal or gastric perforations are rare and present with fever, tachycardia, and other signs of sepsis.

Long-term complications associated with Nissen fundoplication include gas bloat syndrome, dysphagia, and recurrent GERD. Gas bloat syndrome is poorly defined and often attributed to any pain or discomfort following Nissen fundoplication. Symptoms include crampy abdominal pain and gastric distention. These symptoms can often be managed by slowing the rate of feedings or other manipulations of the feeding regimen.

Dysphagia commonly occurs right after surgery and improves over time. Some patients may require esophageal dilation in the immediate postoperative period. Some studies report that such dilations are required in up to 12% of patients. Dilation has shown to increase the risk of recurrent GERD.

The overall rate of recurrent GERD is difficult to define. One study showed that over 70% of patients were prescribed antireflux medications within one year of Nissen fundoplciation, thus making recurrent reflux as the most common complication following Nissen fundoplication. Recurrent GERD is also the most common complication requiring revisional surgery. Multiple risk factors increase the risk of recurrence and include young age at the time of fundoplication, neurologic impairment, history of esophageal atresia, presence of delayed gastric emptying, need for esophageal dilation, and circumferential dissection of the esophagus.

@Nora Atiah, do you routinely do selective vagotomy with fundo cases ?