Complications after anti-reflux surgery.

Anti-reflux operations are frequently performed in a variety of different hospital categories. Surgical repair of the reflux-preventing mechanisms is very effective in preventing a relapse of the reflux, but the side effects of surgery sometimes mar an otherwise excellent postsurgical result. The side effects of anti-reflux surgery are mainly due to an overcorrection of the anti-reflux mechanisms in the gastro-oesophageal junction area. A restrained passage of swallowed food through the gastro-oesophageal junction is a fairly regular phenomenon postoperatively, although it causes astonishingly few symptoms except during the early postoperative period. No patient should be able to vomit after a well-functioning anti-reflux procedure, although the ability to belch is usually reported to be maintained despite objective evidence to suggest significant deficiencies, which may cause bloating and rectal flatulence. A variety of factors have been suggested to counteract some of the side effects of anti-reflux surgery. The best-documented preventive strategy presented so far is to carry out a posterior partial fundoplication and to ensure that the patient is operated on in a high-volume, specialised centre.