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Early recognition and prompt laparoscopic revision improve outcomes in patients with acute wrap migration after anti-reflux surgery. Timely intervention prevents serious gastric complications and results in durable long-term surgical success.
Acute trans-diaphragmatic wrap migration is an uncommon but potentially life-threatening complication of laparoscopic anti-reflux surgery. If diagnosis is delayed, gastric obstruction, ischemia, or recurrent hiatal hernia may develop, making rapid surgical intervention essential.
To better understand this complication, investigators retrospectively reviewed 10 patients (median age 41 years) who developed acute transdiaphragmatic wrap migration within 7 days of anti-reflux surgery. Every patient underwent urgent computed tomography, followed by emergency laparoscopic revision within 24 hours of presentation. Surgical repair focused on restoring normal anatomy and repairing the diaphragmatic defect, with additional procedures performed when required.
Recovery was encouraging. Most patients resumed oral liquids soon after surgery and progressed to a soft diet during the first postoperative week. During 2 years of follow-up, only 2 patients required intermittent proton pump inhibitor therapy, while the remaining patients remained symptom-free. Follow-up imaging showed no recurrent hiatal hernia, supporting the durability of early laparoscopic repair.
The study highlights an important surgical principle: early diagnosis should be followed by immediate laparoscopic revision rather than delayed intervention. In experienced hands, prompt management can prevent severe gastric complications and deliver excellent long-term outcomes, even after this rare postoperative emergency.
Journal of Minimal Access Surgery
Acute wrap migration after anti-reflux surgery: The devil is in the details
Vishakha Kalikar et al.
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