In the Nissen fundoplication for GERD, what is the most common long-term complication leading to reoperation?

• A Esophageal perforation during surgery
• B Recurrent GERD due to wrap slippage or herniation ✓
• C Trocar site incisional hernia
• D Conversion to open surgery

Explanation

The most common long-term complication of Nissen fundoplication requiring reoperation is recurrent GERD due to wrap disruption, slippage, or herniation of the wrap through the hiatus back into the mediastinum. Other complications include gas-bloat syndrome, dysphagia (from an overly tight wrap), and inability to belch or vomit. The reoperation rate is 3–6% at 10 years. Partial fundoplication (Toupet — posterior 270°, or Dor — anterior 180°) is associated with less dysphagia but slightly higher GERD recurrence.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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