Reoperation for complications of the Nissen fundoplication.

Case histories of 25 patients are reported in whom complications after a Nissen fundoplication were sufficiently severe to require reoperation. Patients were classified by complications as having postoperative dysphagia (14), recurrent reflux (seven), "gas bloat" syndrome (two), and paraesophageal hernia (two). Six of the 14 patients with dysphagia had no esophageal peristalsis, one had a panmural fibrous stricture, and had a "slipped" Nissen, and in six the wrap was presumed to have been fashioned too tightly. Too tight a wrap was also responsible for the seven instances of recurrent reflux and the two of "gas bloat" syndrome. Revision of the fundoplication relieved the symptoms in the 15 patients in whom it was done. A variety of surgical procedures were performed on the other 10, all but one of whom experienced a good result. Proper selection of patients for operation coupled with attention to certain technical surgical details will ensure good results in 90% of patients after a Nissen fundoplication.