Nissen Fundoplication, Dysphagia and Gastroparesis
Angela from Houston sent us this question: “My 33-year-old daughter had a fundoplication when she was 4 months old due to severe reflux that was inhibiting her ability to gain weight. Ever since her surgery, she has suffered with retching. She’s been diagnosed with Barrett’s and gastroparesis and has constant abdominal pain and excessive flatulence. Within the past several years, she has developed serious dysphagia. She’s had the fundoplication stretched several times and had Botox injected the last time (about 6 months ago) but the dysphagia has returned. What options do you feel are available to relieve these symptoms?”
Vagal nerve injury after Nissen fundoplication may result in gastroparesis. Retching, bloating and abdominal pain are classic symptoms of gastroparesis. Constant retching may disrupt the Nissen fundoplication and result in a recurrent hiatal hernia. Barrett’s esophagus and dysphagia may consequently develop. Other causes for late onset dysphagia after Nissen fundoplication may include pseudo-achalasia secondary to a tight wrap or new onset esophageal dysmotility disorder not related to fundoplication surgery.
These symptoms are quite debilitating. Therefore, at Houston Heartburn and Reflux center we strive to perform the most perfect Nissen fundoplication from the very beginning to avoid these issues. The good news is that several treatment options are available to effectively address most of these problems.
The first step to resolving any issue after Nissen fundoplication is proper evaluation and diagnosis by expert acid reflux specialist. For gastroparesis after Nissen fundoplication I have developed an effective minimally procedure that restores gastric motility and eliminates gastroparesis related symptoms. The procedure consists of antrum preserving longitudinal gastrectomy that ends below the fundoplication level. For late onset dysphagia, balloon dilation typically does not work and redo Nissen fundoplication is most often needed. The presence of Barrett’s esophagus indicates poor acid reflux control. Revision Nissen fundoplication and redo hiatal hernia are indicated in this case.