Intrathoracic fundoplication for shortened esophagus. Treacherous solution to a challenging problem.

Intrathoracic fundoplication was used in 12 patients with acquired shortening of the esophagus secondary to gastroesophageal reflux. While several patients had excellent results using this approach, five major complications occurred. One patient developed a paraesophageal hernia, while four had ulceration within the wrap itself. One had serious hemorrhage, while another required reoperation to dismantle the intrathoracic wrap. One patient developed a gastrobronchial fistula and eventually died from pulmonary sepsis. The cause of these problems is unknown, but delayed gastric emptying was implicated in two patients. Even though leaving a Nissen fundoplication in the chest seems to be an attractive alternative when the surgeon cannot reduce the wrap below the diaphragm, this alternative is fraught with treacherous complications in a large percentage of patients.