Post Nissen Fundoplication Retching
Background
- Occurs in up to 20% of patients
- Thought to be due to irritation of vagal trunks leading to
sensory mediated activation of the emetic reflex
- Can lead to shearing forces and wrap failure
Interventions:
- Modification of feeding: changing formula
- Smaller feedings more frequently
- Continuous feedings
- Medications:
- Dopamine receptor-2 antagonists (metoclopramide),
- Antiemetics (ondansetron)
- Serotonin receptor antagonist (cyproheptadine)
50% of patients will need to start/restart PPI for recurrence of
GERD symptoms (usually within 10-15yrs)
- Consider surgical revision of fundoplication if:
- Wrap is too loose or dislocated (a slipped Nissen)
- Persistence/recurrence of GERD symptoms
- Postoperative hiatus hernia
Vertical gastropexy involves suturing the stomach to the abdominal
wall and may resolve intractable retching in some cases