Laparoscopic Revision of Nissen to Partial Fundoplication 20 Years After Initial Surgery as an Infant

Brianne Wiemann, MD, Cyril Kamya, MD, Edward Auyang, MD

Department of Surgery, University of New Mexico Hospital, Albuquerque, NM.

ABSTRACT

We report a case of a 21-year-old male who presented with adult-onset dysphagia after previous Nissen fundoplication initially created at age 10.5 months. The patient first presented one year ago to a different hospital, where he underwent extensive workup for his symptomatology. Physiologic tests performed were esophagogastroduodenoscopy (EGD), ab- dominal ultrasound, hepatobiliary iminodiacetic acid scan, esophageal manometry, and lactulose breath test. The EGD identified stricture at the level of the gastroesophageal junction. The other studies did not reveal other physiologic causes for his symptoms. The patient then presented to our institution, at which time a repeat EGD showed evidence of tight Nissen fundoplication. The patient subsequently underwent laparoscopic exploration, which revealed that the fundopli- cation had was partially disrupted, herniated, and twisted causing a long-segment distal stricture. To alleviate the patient’s presenting symptom of dysphagia as well as prevent possible future reflux, it was decided to convert repair the hernia and revise the Nissen into a partial fundoplication. This was successfully accomplished laparoscopically with sub- sequent resolution of the patient’s symptoms.

Key Words: Pediatric GERD, Nissen fundoplication, Toupet fundoplication, Dysphagia.

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