title: Complications of intrathoracic Nissen fundoplication.
abstract: This report details our experience with 30 patients who had Nissen fundoplication. Six underwent transabdominal Nissen fundoplication, and 10 had transthoracic Collis-Nissen with the gastric wrap in a subdiaphragmatic position. Ten patients had a transthoracic Nissen with the wrap in a supradiaphragmatic position. Four patients had a transthoracic Thal-Nissen procedure. In 1 of 4 patients with a Thal-Nissen procedure, intrathoracic rupture of the stomach with gastro-bronchial fistula developed and necessitated left lower lobectomy. Four of 10 patient in whom the gastric wrap was left in the chest experienced severe complications: in 1 patient a lesser curvature ulcer developed and required hemigastrectomy; 1 patient had herniation of the fundoplication with gastric outlet obstruction and required operation for its correction; 2 patients had intrathoracic rupture of the gastric wrap and ultimately died. The 6 patients with transabdominal Nissen and the 10 with transthoracic Collis-Nissen with wrap placed in the abdomen did well This experience severely condemns the practice of leaving the fundoplication above the diaphragm.
mesh_terms: D000368:Aged; D004940:Esophageal Stenosis / Q000601:surgery; D004942:Esophagitis, Peptic / Q000601:surgery*; D005260:Female; D006551:Hernia, Hiatal / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D013270:Stomach / Q000601:surgery*; D013276:Stomach Ulcer / Q000601:surgery; D013903:Thoracic Surgery / Q000379:methods*