title: Management of complications after laparoscopic Nissen's fundoplication: a surgeon's perspective.
abstract: BACKGROUND
  Gastro-oesophageal reflux disease (GORD) is a common problem in the Western countries, and the interest in the minimal access surgical approaches to treat GORD is increasing. In this study, we would like to discuss the presentations and management of complications we encountered after Laparoscopic Nissen's fundoplication in our District General NHS Hospital. The aim is to recognise these complications at the earliest stage for effective management to minimise the morbidity and mortality.
  
  
  METHODS
  301 patients underwent laparoscopic treatment for GORD by a single consultant surgeon in our NHS Trust from September 1999. The data was prospectively collected and entered into a database. The data was retrospectively analysed for presentations for complications and their management.
  
  
  RESULTS
  Surgery was completed laparoscopically in all patients, except in five, where the operation was technically difficult due to pre-existing conditions. The complications we encountered during surgery and follow-up period were major intra-operative bleeding (n = 1, 0.33%), severe post-operative nausea and vomiting (n = 1, 0.33%), wound infection (n = 3, 1%), port-site herniation (n = 1, 0.33%), wrap-migration (n = 2, 0.66%), wrap-ischaemia (n = 1, 0.33%), recurrent regurgitation (n = 4, 1.32%), recurrent heartburn (n = 29, 9.63%), tension pneumothorax (n = 2, 0.66%), surgical emphysema (n = 8, 2.66%), and port-site pain (n = 4, 1.33%).
  
  
  CONCLUSIONS
  Minimal access approach to treat GORD has presented with some specific and unique complications. It is important to recognise these complications at the earliest possible stage as some of these patients may present in an acute setting requiring emergency surgery. All members of the department, and not just the members of the specialised team, should be aware about these complications to minimise the morbidity and mortality.
authors.affiliation: The Princess Royal University Hospital, Bromley Hospitals NHS Trust, Farnborough Common, Orpington, Greater London, Kent, BR6 8ND, UK. tasneemtarun@hotmail.com
authors.forename: Tarun
authors.initials: T
authors.lastname: Singhal
authors.forename: Santosh
authors.initials: S
authors.lastname: Balakrishnan
authors.forename: Abdulzahra
authors.initials: A
authors.lastname: Hussain
authors.forename: Starlene
authors.initials: S
authors.lastname: Grandy-Smith
authors.forename: Andrew
authors.initials: A
authors.lastname: Paix
authors.forename: Shamsi
authors.initials: S
authors.lastname: El-Hasani