Introduction

Transplantation of the stomach occurs as part of a multivisceral or modified multivisceral transplant. Severe gastroesophageal reflux (GER) is a common complication associated with stomach transplantation, often resulting in post-transplant symptoms that negatively impact quality of life. This paper presents the use of gastric fundoplication (FP) as an effective surgical intervention to prevent reflux symptoms in these patients.

Methods

This single center retrospective analysis reviews stomach transplant patients between 2004 and 2012. Patients were divided into fundoplication (FP) or no-FP study groups. All post-transplant gastric studies were reviewed. The procedure was performed as either a complete or partial wrap depending upon stomach size and mobilization. In most patients, the entire donor stomach was transplanted. In each case, the wrapped portion was secured with 3 or 4 stitches.

Results

There were 134 stomach transplants in 124 patients, 104 adult and 30 pediatric. There were 57 of the 134 transplants in which FP was performed (43%). Among the non-FP patients, 3 have required post-transplant reoperation to perform a FP wrap because of the severity of their reflux symptoms which were refractory to all non-surgical therapies. Among the FP patients, none have developed clinically significant reflux, and many have stopped their acid-reducing medications. Among FP patients, one developed a stricture at the gastroesophageal anastomosis which responded to endoscopic dilation and this patient is now symptom free. This procedure was equally effective in adults and children.

Conclusions

Severe reflux associated with stomach transplantation is very common. FP of the transplant stomach results in a near complete elimination of this post-transplant problem, with low risk of complication. Other gastric complaints post-transplant may include vomiting, poor motility, and bloating. Fundoplication wrap of the transplant stomach may be helpful in minimizing symptoms from these other complaints and is now the standard of care at our center.

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