Anatomical deformities after laparoscopic antireflux surgery

Laparoscopic Nissen, Nissen-Rossetti, cardial calibration with gastropexy, and other modifications are the procedures commonly used for surgical treatment of gastroesophageal reflux disease. Postoperative failures have been reported ranging from 10% to 15% associated with postoperative symptoms or recurrent gastroesophageal reflux. In this paper, we present 38 patients submitted to different procedures in which different "abnormal" deformities were found during the postoperative radiological evaluation with barium swallow. The symptoms associated with these deformities were pain (62%), dysphagia (43%), early satiety (37%), postprandial discomfort (35%), and recurrent postoperative reflux (30%). Dysphagia and pain were frequently observed after the Nissen-Rossetti technique, in which a bilobed stomach and stricture (46%) were confirmed. Hiatal hernia was observed in two patients, and slipped Nissen in one patient associated to pain and early satiety. Patients were submitted to conservative treatment (endoscopic dilatation, proton pump inhibitors, and prokinetics), but 10 patients were submitted to redo surgery. There were no complications, and good results were obtained after redo operations.