[Severe and late complications after Nissen's procedure].

Eleven severe complications have been observed in 8 patients operated on with Nissen's procedure. The average time of occurrence of these lesions is of 4 years and 7 months +/- 3 years and 10 months (extreme values 9 months-11 years and 3 months). These patients were 3 women and 5 men of a mean age of 42 +/- 11 years (extreme ages 25-61 years). The complications are of two different types. In 5 cases they consist in the perforation of a gastric ulcer into the pericardium, the mediastinum, the pleura or one of the crura of the diaphragm. The diagnosis is established by Christ Ray and esogastroduodenal gastrograffin follow-through. A quite different picture is that of hemorrhagic ulcer occurring abruptly without any warning signs in 6 cases, causing cataclysmal bleeding in three. The etiological diagnosis is based on fibroscopy. Two patients had multiple complications. In three cases there were in addition obvious signs of disorders of gastric emptying and in one case alkaline reflux. The perforated ulcers were all treated by suture, but for the bleeding ulcers total or upper partial gastrectomy was required in 2 of 6 cases. No hospital mortality or morbidity was noted. The pathogenesis of these complications is controversial, but they seem to be caused by disorders of gastric emptying or alkaline reflux. The occurrence of these complications leads to call into question the indications of Nissen's procedure in the treatment of gastroesophageal reflux. The treatment must be medical at first.(ABSTRACT TRUNCATED AT 250 WORDS)