Nissen Conversion to Toupet Fundoplication

Nissen Conversion to Toupet Fundoplication

Diane from Corpus Christi sent us this question: “I had a redo lap Nissen fundoplication via Toupet procedure for GERD surgery done 20 years ago.  I’m 8 months post op, still having epigastric pain/burping…had severe constipation in the beginning and had to push to have a bowel movement. Could the wrap have slipped?

Dear Diane,

Straining due to constipation or coughing increases intra-abdominal pressure. Increased intra-abdominal pressure in the early post-operative period may result in hiatal hernia recurrence. In this this case, the wrap does not slip but rather moves up into the chest along with the esophagus. By the same token, a poorly constructed Nissen or Toupet fundoplication may slip independent of increased intra-abdominal pressure. Another cause for recurrent acid reflux symptoms after revision surgery include the development of gastroparesis secondary to vagal nerve injury. Vagal nerve injury may also result in constipation.

Whatever is the underlying cause, you need to consult with your acid reflux surgeon. A thorough evaluation including upper endoscopy provides important information on the repair. Wrap slippage and recurrent hiatal hernia are easily diagnosed. Gastroparesis may require a gastric emptying study to confirm.

Once a diagnosis is made, a tailored solution is offered. Gastroparesis is difficult to treat but we have developed an effective procedure at Houston Heartburn and Reflux Center that promotes gastric emptying. If you suffer from gastroparesis, please give us a call at 832-945-8717. We may be able to help you.