COMPLICATIONS ASSOCIATED WITH LAPAROSCOPIC ANTIREFLUX SURGERY - ONE MULTISPECIALTY CLINICS EXPERIENCE

Background: The records of all patients with significant complications of laparoscopic anti-reflux surgery (LARS) seen at our institution be tween June 1993 and September 1996 were reviewed. Specifically exclude d were patients who had mild perioperative complications or postoperat ive dysphagia that either did not require bougienage or responded to o ne to two dilations. Data collected included patient demographics; typ e of surgery; complication and its presentation; response to medical, endoscopic, and/or surgical therapy; and outcomes. Results: Nine patie nts (five men and four women, mean age 59 years) presented at a mean o f 4 months post-LAPS (seven Nissen fundoplications and two Hill poster ior gastropexy repairs). Symptoms included refractory dysphagia (4), i ntractable gas bloat (5), various degrees of chest or abdominal pain ( 4), and incapacitating diarrhea (3). Findings included tight repair (4 ), vagal nerve injury with gastroparesis (4) and/or diarrhea (3), and esophageal or gastric perforation (3). Additional findings included pr oximal gastric ulcers (3), volvulus (1), and incarcerated intrathoraci c hernia (1). Patients with dysphagia had moderate improvement after a mean of 3 +/- 0.6 (standard error of the mean) additional dilations, whereas four patients required five reoperations to date. Seven of the nine patients had clinical improvement, whereas two had refractory sy mptoms at a mean follow-up of 10 months. Conclusions: Although LARS ha s supplanted open surgery in many centers, refractory complications oc cur in a subset of patients and require reoperation in approximately o ne half of those referred to a multispecialty clinic.