Complications - Myotomy and Fundoplication according to Dor, robotically assisted

Injury to the Spleen

• Avoidance through subtle preparation
• Therapy through robotic hemostatic measures (coagulation, hemostatics) and splenectomy as ultima ratio

Esophageal/Stomach Wall Injury

• Avoidance through subtle preparation
• Diagnostics through intraoperative blue test possible
  Therapy through oversewing of the defect and covering with the cuff in the ideal case
• if necessary, intraoperative endoscopic control

Pneumothorax

• due to injury to the parietal pleura during mediastinal preparation
• only significant in case of cardiopulmonary problems intraoperatively
• in stable patient initially without consequence
• in case of increasing ventilation pressure or poor oxygenation, first reduction of intra-abdominal pressure and increase of positive inspiratory pressure 
• if necessary, otherwise intraoperative chest drainage. Completion of the operation robotically with drainage in place 
• at the end of the OP good ventilation of the lung through manual ventilation with open trocars

Bleedings 

Short gastric arteries: 

• Possible complicationin transection of the short gastric arteries for gastric fundus mobilization 
• Hemostasis can be demanding in case of poor exposure with strong visceral adiposity.

Diaphragmatic veins: 

• In close proximity to the hiatus
• Hemostasis can also be demanding

Aorta:

• Runs behind the hiatus
• An injury is theoretically possible 

Early Complications (within the first days to weeks)

Mucosal Perforation

• Can occur during surgery and lead to leaks postoperatively.
• Symptoms: Fever, chest pain, sepsis.
• Diagnosis: CT with contrast medium or endoscopy.
• Treatment: Conservative treatment (e.g., fasting, antibiotics) or reoperation.

Bleeding/Hematomas

• Cause: Injury to vessels during myotomy or fundoplication.
• Symptoms: Anemia, tachycardia, hypotension.
• Treatment: Observation, blood transfusion or possibly reoperation.

Infections (Abscess, Wound Infection, Mediastinitis, Peritonitis)

• Possible in case of perforation or leakage.
• Treatment: Antibiotics, possibly surgical drainage.

Early Postoperative Gastroesophageal Reflux (GERD)

• Since the lower esophageal sphincter is severed, acidic gastric juice can flow back into the esophagus.
• Symptoms: Heartburn, regurgitation, esophagitis.
• Treatment: initially proton pump inhibitors (PPI)

Late Complications (Weeks to Months after Surgery)

Persistent or Recurrent Dysphagia

• Cause: Incomplete myotomy or scar formation.
• Treatment: Balloon dilatation, Botox injection, reoperation.

Gastric Emptying Disorders (e.g., Postoperative Gas-Bloat Syndrome)

• Due to fundoplication, the ability to release gas may be restricted.
• Symptoms: Bloating, early satiety, nausea.
• Treatment: Adjust diet, prokinetic medications.

Esophageal Dilatation or Pseudo-Diverticulum Formation

• Can arise due to persistent high pressure in the esophagus.
• Treatment: Endoscopic or surgical intervention.

Late Postoperative Gastroesophageal Reflux (GERD)

• Since the lower esophageal sphincter is severed, acidic gastric juice can flow back into the esophagus.
• Symptoms: Heartburn, regurgitation, esophagitis.
• Treatment: initially proton pump inhibitors (PPI), possibly revision or conversion of the fundoplication in the course