From the Guidelines
Gastroparesis is not a common complication of Nissen fundoplication surgery, but it can occur in some patients. Nissen fundoplication is a procedure that strengthens the lower esophageal sphincter to treat gastroesophageal reflux disease (GERD) [ 1 ]. While most patients recover without significant issues, a small percentage may experience delayed gastric emptying or gastroparesis following the procedure. This complication typically manifests as nausea, vomiting, early satiety, bloating, and abdominal discomfort. The mechanism behind post-fundoplication gastroparesis likely involves vagal nerve injury during surgery or altered gastric accommodation due to the anatomical changes created by the wrap.
Some of the key points to consider in the management of gastroparesis include:
- Dietary modifications, such as small, frequent, low-fat, low-fiber meals, can help alleviate symptoms [ 1 ].
- Medications such as metoclopramide 5-10mg before meals, domperidone (where available) 10mg before meals, or erythromycin 50-100mg before meals may be used to treat gastroparesis [ 1 ].
- In severe cases that don't respond to conservative management, surgical interventions like pyloroplasty or gastric electrical stimulation might be considered [ 1 ].
- Most cases of post-fundoplication gastroparesis are temporary and resolve within several weeks to months as the body adapts to the new anatomy.
It's essential to note that the evidence regarding the benefits of metoclopramide for the management of gastroparesis is weak, and its use beyond 12 weeks is no longer recommended by the FDA or the European Medicines Agency due to the risk of serious adverse effects [ 1 ]. Therefore, treatment options should be carefully considered and tailored to each patient's specific needs.
From the Research
Gastroparesis as a Complication of Nissan Fundoplication Surgery
- Gastroparesis is a potential complication of laparoscopic Nissen fundoplication, although it is considered uncommon 2.
- The development of postoperative gastroparesis after either an open or laparoscopic Nissen fundoplication may result in significant morbidity 2.
- Gastroparesis, caused by delayed emptying of the stomach, has been shown to be associated with Nissen fundoplication 3.
Frequency and Management of Gastroparesis
- Approximately 80% of patients complain of various symptoms immediately after laparoscopic Nissen fundoplication, but most of these symptoms resolve within 3 months 4.
- Persistent symptoms after 3 months may warrant evaluation for operative failure, including gastroparesis 4.
- Laparoscopic pyloroplasty has been shown to improve or normalize gastric emptying in nearly 90% of gastroparesis patients with very low morbidity 5.
Diagnostic Approach and Treatment
- Post-fundoplication symptoms and complications require a diagnostic approach to determine the best possible treatment, including evaluation for anatomic abnormalities and esophageal and gastric function alterations 6.
- The treatment of gastroparesis after Nissen fundoplication may involve dietary management, medical treatment, or surgical interventions such as laparoscopic pyloroplasty or gastric stimulator implantation 3, 5.