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Prospective study of the effect of laparoscopic Nissen fundoplication on reflux mechanisms.
Br J Surg 2001; 88(11):1519-24BJ

Abstract

BACKGROUND

Laparoscopic Nissen fundoplication effectively reduces acid reflux and reflux symptoms. Little is known about the effect on reflux mechanisms, especially on transient lower oesophageal sphincter relaxations (TLOSRs).

METHODS

Twenty-seven patients were studied prospectively before and after laparoscopic Nissen fundoplication, by simultaneous recording of pH and lower oesophageal sphincter (LOS) characteristics using sleeve manometry. In all of the 27 patients the operation was judged successful, based on major improvement or resolution of reflux symptoms and acid reflux. Vagus nerve integrity was studied indirectly by the secretion of pancreatic polypeptide (PP) in response to insulin-induced hypoglycaemia.

RESULTS

After fundoplication basal LOS pressure increased significantly from mean(s.e.m.) 13(1) to 22(1) mmHg (P < 0.001). Laparoscopic Nissen fundoplication significantly decreased the frequency of TLOSR in the fasting period from mean(s.e.m.) 2.5(0.5) to 0.6(0.2) per h, and in the postprandial period from 4.0(0.4) to 1.3(0.3) per h (P < 0.01). The percentage of TLOSRs associated with reflux also decreased significantly from 24(10) to 0(0) per cent in the fasting period and from 42(6) to 12(6) per cent in the postprandial period, before and after fundoplication respectively (P < 0.01). After operation the PP response was abnormal in three patients, pointing to vagus nerve dysfunction. Postoperative TLOSR frequency and LOS pressure were no different between patients with and without vagus nerve dysfunction.

CONCLUSION

Laparoscopic Nissen fundoplication significantly increased fasting and postprandial LOS pressure and significantly decreased the rate of TLOSR. This resulted in a significant reduction in oesophageal acid exposure but postprandial LOS characteristics were preserved.

Authors+Show Affiliations

Department of Gastroenterology-Hepatology, Leiden University Medical Center, Leiden, The Netherlands.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

11683752

Citation

Straathof, J W., et al. "Prospective Study of the Effect of Laparoscopic Nissen Fundoplication On Reflux Mechanisms." The British Journal of Surgery, vol. 88, no. 11, 2001, pp. 1519-24.
Straathof JW, Ringers J, Masclee AA. Prospective study of the effect of laparoscopic Nissen fundoplication on reflux mechanisms. Br J Surg. 2001;88(11):1519-24.
Straathof, J. W., Ringers, J., & Masclee, A. A. (2001). Prospective study of the effect of laparoscopic Nissen fundoplication on reflux mechanisms. The British Journal of Surgery, 88(11), pp. 1519-24.
Straathof JW, Ringers J, Masclee AA. Prospective Study of the Effect of Laparoscopic Nissen Fundoplication On Reflux Mechanisms. Br J Surg. 2001;88(11):1519-24. PubMed PMID: 11683752.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Prospective study of the effect of laparoscopic Nissen fundoplication on reflux mechanisms. AU - Straathof,J W, AU - Ringers,J, AU - Masclee,A A, PY - 2001/10/31/pubmed PY - 2002/1/5/medline PY - 2001/10/31/entrez SP - 1519 EP - 24 JF - The British journal of surgery JO - Br J Surg VL - 88 IS - 11 N2 - BACKGROUND: Laparoscopic Nissen fundoplication effectively reduces acid reflux and reflux symptoms. Little is known about the effect on reflux mechanisms, especially on transient lower oesophageal sphincter relaxations (TLOSRs). METHODS: Twenty-seven patients were studied prospectively before and after laparoscopic Nissen fundoplication, by simultaneous recording of pH and lower oesophageal sphincter (LOS) characteristics using sleeve manometry. In all of the 27 patients the operation was judged successful, based on major improvement or resolution of reflux symptoms and acid reflux. Vagus nerve integrity was studied indirectly by the secretion of pancreatic polypeptide (PP) in response to insulin-induced hypoglycaemia. RESULTS: After fundoplication basal LOS pressure increased significantly from mean(s.e.m.) 13(1) to 22(1) mmHg (P < 0.001). Laparoscopic Nissen fundoplication significantly decreased the frequency of TLOSR in the fasting period from mean(s.e.m.) 2.5(0.5) to 0.6(0.2) per h, and in the postprandial period from 4.0(0.4) to 1.3(0.3) per h (P < 0.01). The percentage of TLOSRs associated with reflux also decreased significantly from 24(10) to 0(0) per cent in the fasting period and from 42(6) to 12(6) per cent in the postprandial period, before and after fundoplication respectively (P < 0.01). After operation the PP response was abnormal in three patients, pointing to vagus nerve dysfunction. Postoperative TLOSR frequency and LOS pressure were no different between patients with and without vagus nerve dysfunction. CONCLUSION: Laparoscopic Nissen fundoplication significantly increased fasting and postprandial LOS pressure and significantly decreased the rate of TLOSR. This resulted in a significant reduction in oesophageal acid exposure but postprandial LOS characteristics were preserved. SN - 0007-1323 UR - https://www.unboundmedicine.com/medline/citation/11683752/Prospective_study_of_the_effect_of_laparoscopic_Nissen_fundoplication_on_reflux_mechanisms_ L2 - https://onlinelibrary.wiley.com/resolve/openurl?genre=article&amp;sid=nlm:pubmed&amp;issn=0007-1323&amp;date=2001&amp;volume=88&amp;issue=11&amp;spage=1519 DB - PRIME DP - Unbound Medicine ER -