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Intrathoracic Migration of the Wrap After Laparoscopic Nissen Fundoplication

Radiologic Evaluation

Bernard Hainaux1, Azadeh Sattari1, Emmanuel Coppens1, Niloufar Sadeghi1 and Guy-Bernard Cadière2

1 Department of Radiology, CHU Saint-Pierre, Université Libre de Bruxelles, 322 Rue Haute, 1000 Brussels, Belgium.
2 Department of Gastrointestinal Surgery, CHU Saint-Pierre, Université Libre de Bruxelles, 1000 Brussels, Belgium.



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  		Fig. 1A. —Normal laparoscopic Nissen fundoplication in 67-year-old woman. Diagram (A) and fluoroscopic upright frontal image (B) show normal postoperative appearance of Nissen fundoplication. Fundus is wrapped around lower esophagus. Wrap and gastroesophageal junction project entirely below diaphragm. Level of esophageal hiatus (long arrow, B) and diaphragm (short arrows, B) are indicated.

 


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  		Fig. 1B. —Normal laparoscopic Nissen fundoplication in 67-year-old woman. Diagram (A) and fluoroscopic upright frontal image (B) show normal postoperative appearance of Nissen fundoplication. Fundus is wrapped around lower esophagus. Wrap and gastroesophageal junction project entirely below diaphragm. Level of esophageal hiatus (long arrow, B) and diaphragm (short arrows, B) are indicated.

 


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  		Fig. 2A. —Type I intrathoracic migration of wrap in 54-year-old man. Diagram (A) and fluoroscopic upright frontal image (B) show paraesophageal herniation of portion of wrap through esophageal hiatus. Distal esophagus remains below diaphragm. Levels of esophageal hiatus (long arrow, B) and diaphragm (short arrows, B) are indicated.

 


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  		Fig. 2B. —Type I intrathoracic migration of wrap in 54-year-old man. Diagram (A) and fluoroscopic upright frontal image (B) show paraesophageal herniation of portion of wrap through esophageal hiatus. Distal esophagus remains below diaphragm. Levels of esophageal hiatus (long arrow, B) and diaphragm (short arrows, B) are indicated.

 


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  		Fig. 3A. —Type II intrathoracic migration of wrap in 49-year-old man. Diagram (A) and fluoroscopic upright slightly left posterior oblique image (B) show herniation of entire fundoplication through esophageal hiatus. Gastroesophageal junction is located at level of diaphragm. Levels of esophageal hiatus (long arrow, B) and diaphragm (short arrows, B) are indicated.

 


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  		Fig. 3B. —Type II intrathoracic migration of wrap in 49-year-old man. Diagram (A) and fluoroscopic upright slightly left posterior oblique image (B) show herniation of entire fundoplication through esophageal hiatus. Gastroesophageal junction is located at level of diaphragm. Levels of esophageal hiatus (long arrow, B) and diaphragm (short arrows, B) are indicated.

 

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