A 55-year-old man undergoes laparoscopic Nissen fundoplication for GERD. Two years later, he presents with recurrence of heartburn and dysphagia. Endoscopy shows the wrap has herniated into the chest. This post-fundoplication complication is best described as:

• A Slipped Nissen (wrap herniation/intrathoracic migration of the fundoplication) ✓
• B Oesophageal stricture from fundoplication
• C Gas bloat syndrome
• D Recurrent hiatal hernia without wrap migration

Explanation

Intrathoracic migration of the fundoplication wrap (slipped Nissen or 'telescope phenomenon') is a recognised complication of anti-reflux surgery, typically presenting with recurrence of reflux and dysphagia years post-operatively. The wrap slips upward through the hiatus, rendering it ineffective. Diagnosis is by barium swallow or CT; management is laparoscopic redo fundoplication with adequate crural closure.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.