A poorly performed Nissen fundoplication will either fall apart or get displaced. The most common form of a displaced Nissen fundoplication is a slipped wrap. We have previously discussed wrap slippage (https://houstonheartburn.com/slipped-nissen-fundoplication-why-do-we-still-see-it). In short, a slipped Nissen fundoplication occurs because of poor surgical technique and incomplete esophageal mobilization during hiatal hernia repair. A less common form of displaced wrap is a twisted Nissen fundoplication. A twisted wrap is also the result of poor surgical technique, and incomplete mobilization of gastric fundus. Gastric fundus, (dome of stomach), is attached, laterally, to spleen via short gastric blood vessels, and posteriorly, to pancreas via posterior gastric blood vessels and scar tissue. A gastric fundus that is not fully mobilized to comfortably wrap around lower esophageal sphincter, with neither tension in the wrap nor torsion on the esophagus, results in two problems.
First, a poorly mobilized fundus tends to wrap below the esophageal sphincter on the stomach itself because there is not enough length to pull the fundus upward and wrap it around esophagus. This kind of wrap causes significant bloating, discomfort, and difficulty swallowing. Second, a poorly mobilized fundus that is “forced” into a Nissen fundoplication configuration is under lot of tension. A wrap under tension causes the gastric fundus to move back towards its original posterolateral position. In this process, the right lip of the fundoplication moves up and posterior while the left lip of the fundoplication moves down and anterior. The lower esophagus that is typically sutured to fundoplication is now twisted on its longitudinal axis resulting in chest pain, difficulty swallowing, and excessive salivation.
A twisted Nissen fundoplication is diagnosed by upper endoscopy. It requires surgical correction to alleviate debilitating symptoms like dysphagia and pain. A twisted Nissen fundoplication can be avoided using proper surgical technique. At Houston Heartburn and Reflux Center, our rate of slipped or twisted Nissen fundoplication is zero. Our success rate is 100%. If you struggle with acid reflux and you are looking for a safe, reliable, and effective solution for your GERD do not hesitate to give us a call.