Laparoscopy
Teflon pledget reinforced fundoplication causes symptomatic gastric and esophageal lumenal penetration

https://doi.org/10.1016/j.amjsurg.2003.11.028Get rights and content

Abstract

Background

Nissen fundoplication has become the standard operative procedure for the treatment of severe gastroesophageal reflux disease. The use of Teflon pledgets in Nissen fundoplications by our unit has been associated with a number of complications that has led to a change of technique in performing these operations.

Methods

We reviewed our database of all patients who had fundoplications that involved the use of pledgets and identified those who had represented with postoperative complications related to pledget erosion/migration.

Results

We identified 11 patients to date from a total of 1,175 fundoplications who had symptomatic pledget erosion occurring between 2 and 85 months after surgery (mean time 33.3 months). Symptoms included dysphagia, recurrent symptomatic gastroesophageal reflux, chest pain, and melaena, and in some cases significant morbidity was associated with the erosion. No common factor predisposing these patients to pledget erosion was identified. In the majority of cases removal of the pledget was associated with resolution of the symptoms. A review of the literature does not reveal any similar studies but problems associated with the erosion and migration of Teflon prostheses are described.

Conclusions

The use of Teflon pledgets in fundoplication is associated with a small but significant risk of complications that has led to our unit abandoning this technique.

Section snippets

Methods

A prospective computer based record has been kept of all patients operated on by the senior author; patient details being recorded by a data manager on a Microsoft database and Excel spreadsheet. All fundoplications both laparoscopic and operation are recorded individually. Hospital operation records were also reviewed for each case. A review of the literature using the Medline and Pub Med search engines was conducted, using the terms “fundoplication, postoperative complications, pledget,

Results

Symptomatic lumenal penetration of Teflon pledgets to this date has occurred in 11 patients from a total of 1,175 cases in our database, (an incidence of less than 1%). Patients suffering the complication ranged in age from 41 to 74 years with an average age of 55.8 years. There were 6 men (average age 53.2 years) and 5 women (average age 58.8 years). No common factor predisposing these patients to pledget erosion was identified.

Comments

The Teflon pledget buttressed fundoplication was performed with the view to prevent recurrence by reinforcing the wrap using a modification of the technique described in the literature by DeMeester [6]. An earlier paper by DeMeester [9] compared open fundoplication with medical treatment for gastroesophageal reflux and followed up 34 patients with pledget reinforced fundoplication for 2 years. No problems with pledget erosion were documented. Hinder et al [6] also used this technique in their

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