title: Herniation of an abdominal antireflux fundoplication into the chest: what does it mean?
abstract: OBJECTIVE
  The specific contribution of the herniation of an abdominal antireflux fundoplication into the chest to symptomatic and therefore surgical failure remains unclear.
  
  
  METHODS
  The study was conducted in 189 consecutive fundoplication patients, categorized as patients reoperated on for chest herniation of either an abdominal 360° (Group 1; n = 95) or a partial (Group 2; n = 10) fundoplication, and patients having undergone an intrathoracic 360° fundoplication for short oesophagus (Group 3; n = 84; reference group). There were four subgroups in Group 1: 1A: wrap still complete and perioesophageal; 1B: wrap still complete but perigastric; 1C: wrap still perioesophageal but partially disrupted and 1D: wrap perigastric and partially disrupted.
  
  
  RESULTS
  The prevalence of defective symptoms (heartburn and regurgitation) was significantly lower (P < 0.0001) in Group 3 (0.0%) and Subgroup 1A (3.7%) than in Subgroups 1B (84.4%), 1C (86.7%) and 1D (100%) and Group 2 (100%). The prevalence of obstructive symptoms (dysphagia, chest pain, necrosis and perforation) was significantly higher (P < 0.0001) in Subgroup 1A (100%) than in Subgroups 1B (57.8%), 1C (60.0%) and 1D (25.0%). The prevalence of a short oesophagus, an abdominal wall hernia repair and high abdominal pressure episodes in reoperated patients were 13.7, 36.2 and 67.2%, respectively.
  
  
  CONCLUSIONS
  Unlike perigastric or partial fundoplication, a 360° perioesophageal abdominal fundoplication, when herniated into the chest, is still effective against reflux. Obstructive symptoms are due to either diaphragmatic strangulation or perigastric migration of the wrap (slipknot effect). Short oesophagus, weakness of the abdominal wall and high abdominal pressure episodes favour the herniation process.
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Yannick
authors: Y
authors: Deswysen
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Francesco
authors: F
authors: Volonté
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Christian
authors: C
authors: Gutschow
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Renato
authors: R
authors: Romagnoli
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Paolo
authors: P
authors: Strignano
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Aous
authors: A
authors: Ouazzani
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Luc
authors: L
authors: Verstraete
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Charles
authors: C
authors: De Gheldere
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Maximillien
authors: M
authors: Thoma
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Vincent
authors: V
authors: Uluma
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Felicia
authors: F
authors: Ungureanu
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
authors: Jean-Yves
authors: JY
authors: Mabrut
authors: Unit of Upper Gastro-Intestinal Surgery, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium jean-marie.collard@uclouvain.be.
authors: Jean-Marie
authors: JM
authors: Collard
mesh_terms: D000005:Abdomen; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology; D003680:Deglutition Disorders / Q000209:etiology; D004947:Esophagus / Q000601:surgery; D005260:Female; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods; D005764:Gastroesophageal Reflux / Q000601:surgery*; D046449:Hernia, Abdominal / Q000209:etiology / Q000601:surgery; D006551:Hernia, Hiatal / Q000209:etiology* / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D011312:Pressure; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D017211:Treatment Failure; D055815:Young Adult
keywords: Chest; Gastroesophageal reflux disease; Hiatal hernia; Oesophagus; Reoperation of fundoplication