Iatrogenic thoracic migration of the stomach complicating laparoscopic Nissen fundoplication

Background: Intrathoracic gastric herniation after laparoscopic Nissen fund oplication is an uncommon but potentially life-threatening complication tha t may present in the early or late postoperative period. Methods: A retrospective analysis was performed on all patients undergoing antireflux surgery from December 1991 to June 1999. Results: Nine cases of gastric herniation occurred after 511 operations (0. 17%). Patients presented with the condition 4 days to 29 months after surge ry. Eight of these nine patients (89%) had reported vomiting in the immedia te postoperative period. Seven patients (78%) reported persistent odynophag ia. A factor common to all patients was chat posterior crural repair had no t been performed. Conclusions: Measures should be undertaken to prevent postoperative vomitin g after laparoscopic Nissen fundoplication. Posterior crural repair is esse ntial after surgery in all cases.