High gastric ulcer after Nissen fundoplication.

Three of 100 patients who underwent Nissen fundoplication developed gastric ulcers, all high on the lesser curve. Two patients presented one year after, and the third seven years after fundoplication. All healed with medical therapy, but a relapse in one patient necessitated partial gastrectomy. The pathogenesis, is not known, but vascular factors may be relevant. Patients complaining of epigastric pain after fundoplication require careful endoscopic examination for ulcer, especially near the cardia, since this may be a site of predilection.