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Problems Associated With a Nissen Fundoplication Following Tracheoesophageal Fistula and Esophageal Atresia Repair
Michael R. Curci, MD;
Albert W. Dibbins, MD
Arch Surg. 1988;123(5):618-620.
Abstract
• Gastroesophageal reflux is frequently associated with esophageal atresia and tracheoesophageal fistula repair. Following unsuccessful medical treatment, 14 (45%) of 31 patients underwent a Nissen fundoplication. Five of these 14 patients had prolonged dysphagia requiring supplemental gastrostomy feeding. Four of these five patients underwent postoperative manometry and extended pH monitoring, which revealed a normal lower-esophageal sphincter pressure (>15 mm Hg), normal pH results, and marked esophageal dysmotility. The fundoplication creates a mechanical obstruction for those patients with a dyskinetic esophagus who cannot generate the pressure to open the "new sphincter." To avoid this complication, antireflux surgery should be deferred, If possible, in those patients with severe gastroesophageal reflux and marked esophageal motility abnormalities.
(Arch Surg 1988;123:618-620)
Author Affiliations
From the Department of Surgery, Maine Medical Center, Portland.
Footnotes
Accepted for publication Jan 27, 1988.
Read before the Annual Meeting of the New England Surgical Society, Bretton Woods, NH, Sept 13, 1987.
Reprint requests to 7 Bramhall St, Portland, ME 04102 (Dr Curci).
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