GASTROENTEROLOGY ARTICLE OF THE WEEK
September 23, 2004
Spechler SJ. The management of patients who have “failed” antireflux surgery. Am J Gastroenterol doi: 10.1111/j.1572-0241.2004.04081.x
1. A properly constructed fundoplication has the following endoscopic findings
a. Folds of the fundoplication should be under the diaphragm
b. Gastric folds should not be present proximal to the folds of the fundoplication
c. Folds of the fundoplication should be oriented oblique to the white distance
lines on the endoscope
d. the fundoplication folds should measure no more than 1-2 cm in span.
True or False
2. The ideal candidates for antireflux surgery are those who become asymptomatic on acid reduction therapy.
3. Up to 50% of patients may develop functional GI symptoms after fundoplication which are interpreted by patients as recurrence of reflux.
4. Pneumatic dilation can be attempted in patients who have undergone fundoplication and post-operative manometry reveals achalasia.
5. Immediate post-operative dysphagia after fundoplication typically resolves in 2-3 months.
6. Patients who have recurrent symptoms after fundoplication and do not respond completely to PPI’s should undergo surgical revision of the wrap.
7. Fundoplication usually accelerates gastric emptying of solids and liquids.
8. Prior fundoplication is a relative contraindication to esophageal dilation.
9. Gas bloat syndrome after fundoplication may develop as a result of vagal injury and impaired gastric emptying.
10. Diarrhea is a frequent complication of anti-reflux surgery.