Complications of Reflux Surgery (Reflux)

Esophagogastrography in a 9.2-year-old boy after fundoplication. The distal esophagus has a dent which is caused by a contrast-filled pouch starting from the underlying stomach. Postoperatively, a dysphagia was observed in this case instead of expected recurrent vomiting. In addition, salivation, food components getting stuck, regurgitation and choking was present. This postoperative complication is due to a dislocation of a tip of the fundus along the distal esophagus in spite of an intact fundus sleeve. Note the broad folds of the stomach which proceed into the paraesophageal evagination. The diagnosis is a postoperative paraesophageal hiatus hernia. In case of a native upside-down stomach there is a paraesophageal component in addition to the already described classic severe type of hiatus hernia. In case of reflux recurrence the possible pathoanatomical findings are manifold.