Migrative Wrap after fundoplication – A Case Series

Author(s): Nabeel Nazeer, Anirudh Rajkumar, JS Rajkumar, KR Dharmendra, Jayakrishna Reddy, Shreya Rajkumar, Ratnasingam Vaheesan, Akbar S

Laparoscopic Nissen’s fundoplication is an operation that increasingly being used for severe GERD, across the world. Very rarely, the fundal wrap or the gastric esophago junction migrates intrathoracically. This can happen as an acute immediate post operative event or as a chronic migration. We report a case series of 4 patients, who underwent laparoscopic Nissen’s fundoplication and then had migration of wrap. 3 had a chronic wrap migration and presented with dysphagia, 6 months, 9 months and 11 months after surgery. The 4th was an acute post operative wrap migration, which happened in the 2nd post operative day itself. All patients underwent a reduction of the wrap, and meshplasty of the hiatus. All the migrative wrap cases underwent successful laparoscopic surgery. The acute post operative wrap required laparotomy for reduction and a partial sleeve resection of gangrenous stomach. Post operative mortality was nil, and the post operative morbidity was nil too, apart from some dysphagia in the acute wrap patient because of mesh extrusion, 3 years after surgery. This series highlights a rare and ill recognized complication after an increasingly common procedure. Technical details are highlighted.