Post-Nissen Dysphagia and Bloating Syndrome: Outcomes After Conversion to Toupet Fundoplication.
Protracted dysphagia and bloating are potential troublesome side effects following Nissen fundoplication. The aim of this study was to evaluate the effects of conversion from Nissen to Toupet on dysphagia and bloating.



The study used a retrospective chart review of all patients who had undergone conversion from Nissen to Toupet between 2001 and 2014. Endpoints were to determine the effect of conversion on dysphagia, bloating, and reflux control.



Twenty-five patients underwent conversion at a median of 3.7 years (1.4-10.5) after initial fundoplication. Indications were dysphagia in 19 (76%) and bloating syndrome in 6 (24%) patients. The median operative time was 104 min (86-146). There were no serious complications or mortality. Median follow-up was 27 months (0.8-130). Dysphagia was relieved in 16 (84%) and bloating in all 6 patients. Two patients developed reflux requiring a redo-Nissen. Two patients had persistent dysphagia and required endoscopic dilation. The GERD-HRQL post-conversion showed a median score of 5 (3-13).



Conversion relieved dysphagia in 84% and bloating in 100%. Significant recurrence of GERD was rare. Given the absence of serious complications, conversion should be considered in patients with severe bloating or dysphagia.
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Katrin
0000-0003-4174-472X
K
Schwameis
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Jörg
J
Zehetner
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Kais
K
Rona
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Peter
P
Crookes
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Nikolai
N
Bildzukewicz
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Daniel S
DS
Oh
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Geoffrey
G
Ro
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Katherine
K
Ross
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Kulmeet
K
Sandhu
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Namir
N
Katkhouda
Division of Thoracic Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA.
Jeffrey A
JA
Hagen
Division of Upper GI & General Surgery, Department of Surgery, Keck School of Medicine, University of Southern California, 1510 San Pablo Street, #514, 90033, Los Angeles, CA, USA. John.Lipham@med.usc.edu.
John C
JC
Lipham
D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology*; D005260:Female; D005414:Flatulence / Q000209:etiology; D018662:Fundoplication / Q000009:adverse effects* / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D013577:Syndrome
Bloating; Conversion; Dysphagia; Nissen; Toupet