Читать книгу The Esophagus - Группа авторов - Страница 106

The performance of fundoplication in rumination syndrome appears to be contraindicated. This is primarily due to the generation of high intragastric pressures against a newly placed wrap around the gastroesophageal junction. With this physiology, there is a concern about easily undoing the fundoplication and developing gas bloat syndrome. Nevertheless, use of fundoplication in refractory rumination syndrome has been reported in five patients [24]. In this series, all five patients had cessation of regurgitation events with fundoplication, but additionally, one patient required reoperation with reversal of the fundoplication due to persistent dysphagia. Another had severe gas bloat syndrome. Also, in case series of patients with rumination, many report ongoing symptoms respite prior fundoplication [25]. With this data in mind, fundoplication is generally contraindicated and should only be considered for patients with refractory symptoms that cause a major effect on quality of life and health.