Sachin S Kukreja, MD, James R Wallace, MD PhD, Matthew I Goldblatt, MD. University of Illinois at Mount Sinai Hospital, Froedtert Memorial Lutheran Hospital and the Medical College of Wisconsin
The patient is a 32-year-old female who had undergone laparoscopic Nissen fundoplication six years previously for severe gastroesophageal reflux and low-grade Barrett’s dysplasia. She did well for four years until her symptoms returned during pregnancy. Esophagogastroscopy revealed an intact wrap with an intraluminal suture. An Upper Gastrointestinal contrast study also showed an intact fundoplication; however, a hiatal hernia with a paraesophageal component was demonstrated. At time of redo laparoscopic fundoplication, a tissue plane to separate the wrap could not be recognized. Further dissection resulted in partial fundic gastrectomies as well as identification of an esophageal diverticulum secondary to pledgeted suture erosion through the stomach and esophagus from the initial wrap. The diverticulum was confirmed with intraoperative endoscopy and ultimately, a diverticulectomy and re-do Nissen was performed. This case demonstrates the issues of long-term fundoplication durability, the difficulties of revisional gastric surgery, and the risks of foreign bodies and erosion within the GI tract resulting in esophageal diverticulum formation.
Program Number: V038