Complications - EndoStim® Stimulation Therapy of the Lower Esophageal Sphincter

Injury to the left liver lobe with bleeding

• Treatment with electrocoagulation, argon beam, application of hemostatics, suture; possible conversion

Perforation of the esophageal wall

• if suspected:
  > Injection of a dye solution via nasogastric tube
  > also allows detection of very small wall damages with lumen opening
  > depending on defect size, laparoscopic oversewing up to conversion with open repair

Intraoperative pneumothorax

• Cause: Pleural lesion during mobilization of the lower esophagus in the mediastinum, through which CO2 can enter the pleural cavity
• is only significant in the presence of cardiopulmonary problems

Patient stable:

• Continue the procedure without thoracic drainage
• after releasing the pneumoperitoneum, rapid resolution of the pneumothorax is expected

Patient unstable (= increasing ventilation pressure, poor oxygenation)

• Reduction of intra-abdominal pressure, possibly complete release of CO2
• if oxygenation remains poor: thoracic drainage and continuation of the procedure
• Conversion to open procedure rarely necessary

• Dysphagia, generally correctable by reducing the stimulation intensity or turning off the device.
• Denervation syndrome due to damage to the anterior or posterior vagus branch (consequence: gastric emptying disorder, diarrhea)
• Lack of success
• Pain at the implantation site
• Irritations from the stimulation
• Early infections: infections occurring within the first 2 weeks postoperatively, attributable to intraoperative contamination, clinically recognizable as wound healing disorders, prolonged secreting wounds, or infected hematomas with redness and swelling.
• Late infections typically in the context of a bacterial abdominal disease or hematogenous
• Pressure necrosis over the aggregate or the probe
• Trocar hernia