Funduplicatura de Nissen por laparoscopia como técnica de elección para el tratamiento de la enfermedad por reflujo gastroesofágicoLaparoscopic nissen. TIPOS DE FUNDUPLICATURAS. Arantxa [Medicina]. Funduplicatura. Edgar Duran. Tecnicas plastia inguinal. Consultorios Medicos Nealtican. Many translated example sentences containing “funduplicatura de Nissen” – English-Spanish dictionary and search engine for English translations.

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Fatal portal thrombosis after laparoscopic Nissen fundoplication.

Nissen fundoplication

Portal and mesenteric vein thrombosis is a very uncommon complication of laparoscopic surgery, especially after anti-reflux procedures. We report the case of a twenty-year-old man with a history of alcohol and cocaine consumption.

A Nissen fundoplication was performed. On the seventh postoperative day the patient had a portal and mesenteric venous thrombosis, which was confirmed at laparotomy, with both extensive small-intestine necrosis and partial colon necrosis.

Despite anticoagulant therapy, the patient died 24 hours later. Surgical findings were confirmed at necropsy. Portal and mesenteric venous thrombosis is an uncommon but severe and even fatal complication after laparoscopic anti-reflux surgery. When other pro-thrombotic, predisposing conditions such as laparoscopic surgery and cocaine consumption are present, the usual prophylactic doses of low molecular weight heparin might not be sufficient to protect against this life-threatening complication.

Rev Esp Enferm Dig ; Portal and mesenteric vein is a very uncommon complication of laparoscopic surgery. We report the fourth case to our knowledge after laparoscopic Nissen fundoplication. We report the case of a twenty-year-old man having a severe gastroesophageal reflux disease, uncontrolled with omeprazol 60 mg daily, and with a history of alcohol and cocaine consumption.

Upper endoscopy revealed severe esophagitis and an image suggesting Barrett’s esophagus.

Lower esophageal sphincter pressure was 3 mmHg normal range, mmHg. An antireflux procedure was indicated. A pneumoperitoneum was carried out with CO2 at a controlled maximum pressure of 14 mmHg. A short floppy Nissen fundoplication was done with non-absorbable material after adapting the diaphragmatic crura behind the esophagus. Surgery time was minutes, with no incidents. The first hour of postoperative period was uneventful, funduplicautra the patient was discharged asymptomatic.

On the seventh postoperative day the patient ingested excessive amounts of alcohol and food, fuduplicatura suddenly developed a clinical picture consisting of severe back pain, hyperpyrexia, abdominal swelling and hemodynamic instability.


CT findings were small-intestine dilatation, ascites, liver edema, and suspicion of both mesenteric and portal thrombosis. The patient was operated on with the following findings: Intraoperative Doppler ultrasounds showed total thrombosis and air in the portal vein, as well fundplicatura patent mesenteric and hepatic arteries.

No surgical manoeuvre was performed on the vessels. No data suggesting hypercoagulability was found. Urine cocaine detection was not possible, since no sample from the first hours after admission was available. Despite anticoagulation therapy, the patient exhibited a progressive deterioration and died 24 hours after revision surgery. Necropsy showed extensive thrombosis of both the portal and inferior mesenteric veins with hemorrhagic infarction of the whole small intestine fuunduplicatura right colon, acute mucosal ulcers and blood in the intestinal lumen.

Liver hemorrhagic infarction, left ventricular hypertrophy fundpulicatura dilatation, and lung focal microcalcifications a typical finding in chronic cocaine consumers were also found. Hypovolemic, hemorrhagic shock due to portal and mesenteric thrombosis was established as the cause of death. Portal and mesenteric thrombosis after laparoscopic surgery funduplixatura very uncommon.

File:Procedimientos de funduplicatura de tipo – Wikimedia Commons

We report the fourth case ever published in funcuplicatura literature to our knowledge, and the first with a fatal outcome. Portal thrombosis has been reported after laparoscopic surgery of the colon, spleen and gallbladder, but very infrequently after Nissen fundoplication, all having a favorable outcome Two cases also showed additional predisposing conditions to thrombosis: Symptom onset inssen after abundant food ingestion in one case 2 and after food and gassy drink ingestion in our case.

The onset of the portal thrombosis clinical picture may vary from insidious, consisting of mild pain with scanty physical findings, to one of sudden onset with fever, tachycardia and hypotension, later evolving to a shock, as was the case with our patient.

Positive intraabdominal pressure due to pneumoperitoneum may predispose to portal vein occlusion. High pressure causes collapse and, therefore, blood flow resistance increases 2. Also, hypercapnia due to CO2 absorption brings about a decrease in nidsen blood flow as a niasen of vasoconstriction. The effect of all these factors increases with surgery time and is aggravated with the patient’s position on the surgery table 4.


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However, the clinical incidence of portal thrombosis is minimal. We thus believe that there may be another factor playing a central role in its pathogenesis. Technical mistakes were excluded after revising surgery tape records. Could this complication be nissem to cocaine consumption?

The relationship between cocaine consumption and thrombotic and cardiovascular events is well documented, including digestive complications: These may be associated fundupliicatura both acute and chronic consumption. Cocaine provokes severe splanchnic vasoconstriction due to its sympathetic action, thus blocking the reuptake and removal of cathecolamines. It also promotes platelet aggregation and erythrocitosis, and therefore predisposes to arteriolar obstruction.


As a result, both mucosal ulcers and submucosal hemorrhage appear in inssen short term, and pseudomembranes in the long term. Cocaine also has a direct funduplicatufa effect on the gastric mucosa and delays gastric emptying due to its anticholinergic effect and action on medullary centers 5.

The concurrency of all these factors -laparoscopic surgery, chronic cocaine consumption, abundant gassy drink intake in the immediate postoperative period- increased the risk leading funduplicatrua massive portal thrombosis, which was not prevented by the low molecular weight heparin regimen administered.

Would the fatal outcome have been prevented with a longer heparin regimen, with higher doses? Would a different regimen have diminished the severity of the clinical picture? This is not known and remains speculative.

It is therefore useful to preoperatively find any risk-increasing factors in laparoscopic surgery: Then, a cost-effective prophylactic heparin regimen must be defined. Superior mesenteric and portal vein trombosis following laparoscopic fundoplication. Dig Surg ; Spontaneus resolution of a superior mesenteric vein thrombosis after laparoscopic Nissen fundoplication.

Ann R Coll Surg Engl ; Laparoscopic insufflation of the abdomen reduces portal venous flow. Surg Endosc ;