Chest pain after Toupet Fundoplication

Chest pain after Toupet Fundoplication

Michael from Pasadena sent us this question: “I had a Toupet fundoplication for severe acid reflux. I had no acid reflux for 5 days then the flood gate opened, severe chest pain beneath sternum, and burping that last 8-10 seconds all day long.  All these symptoms are new. Did a barium study and they say wrap is intact? What should I do?

Dear Michael,

Severe chest pain beneath the sternum five days after Toupet fundoplication is not normal. It may indicate wrap failure, recurrent hiatal hernia, and recurrent acid reflux. In this case one would expect other symptoms to occur too like heartburn and food regurgitation. A barium swallow is not the best test to check for wrap integrity. Upper endoscopy is a more sensitive test. The wrap may be twisted or slipped. A recurrent hiatal hernia involving the posterior aspect of gastric fundus may also occur resulting in chest pain.

If anatomy is intact, a pH bravo capsule can be placed during endoscopy to measure esophageal acid exposure.

Other causes for chest pain after fundoplication include esophageal spasm. Manometry is a test we commonly use prior to fundoplication surgery to check for esophageal contractions and sphincter pressure.

Of course, other organs in the chest like the heart may cause chest pain. I recommend you get thoroughly evaluated by your surgeon to help identify the cause of your symptoms.

To summarize, a properly performed hiatal hernia repair and Nissen or Toupet fundoplication is associated with very little discomfort after surgery as well as fast recovery. Severe chest pain after Toupet fundoplication is not normal and thorough evaluation by expert acid reflux specialist is recommended.