Outcomes of Nissen fundoplication in patients with gastroesophageal reflux disease and delayed gastric emptying.Arch Surg 2009; 144(9):823-8AS
To investigate the effect of delayed gastric emptying (DGE) on subjective and objective outcomes of gastroesophageal reflux disease following Nissen fundoplication with or without pyloroplasty.
Retrospective analysis of prospectively collected data.
Tertiary care teaching hospital.
A total of 141 consecutive patients considered for Nissen fundoplication who also had suspected DGE based on symptoms.
Of 141 patients, 63 had a time to 50% emptying (T(1/2)) greater than 90 minutes; 47 of the 63 of these had severe DGE (T(1/2) > 150 minutes) and had Nissen fundoplication and pyloroplasty. Sixteen of the 141 with T(1/2) greater than 90 but less than 150 minutes and 78 with normal gastric emptying findings (n = 78) had Nissen fundoplication only.
MAIN OUTCOME MEASURES
Postoperatively, patients with symptom scores greater than 2 and/or abnormal 24-hour pH values (DeMeester score >14.7) were considered to have had unsuccessful treatment. Gastroesophageal reflux disease outcomes were compared between groups 1 and 2. Finally, the outcomes of both groups were compared with a control cohort of 418 patients with Nissen fundoplication and no DGE symptoms (group 3).
At the mean follow-up of 21 months, there were no differences between the 2 groups regarding relief of reflux symptoms (DGE group, 54 of 63 [85.7%] vs NGE group, 71 of 78 [91%]; P = .47) or objective control of acid reflux (DGE group, 33 of 39 [84.6%] vs NGE group, 41 of 51 [80.3%]; P = .78). Dyspeptic symptoms were improved in the DGE group (P < .001); however, the overall incidence remained higher than the NGE group (P = .01). Postoperatively, T(1/2) normalized in 88.23% (15 of 17) of patients. Postoperative objective outcomes were also no different between these groups and patients with Nissen fundoplication who did not have DGE symptoms (n = 418).
Delayed gastric emptying does not affect outcomes of gastroesophageal reflux disease following Nissen fundoplication, but patients with DGE have more postoperative gas and bloat and/or nausea compared with patients with normal gastric emptying; this is mostly corrected by addition of a pyloroplasty.