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Article
August 1994

Should the Vagus Nerves Be Isolated From the Fundoplication Wrap?A Prospective Study

Author Affiliations

From the Departments of Surgery (Drs Peillon, Manouvrier, Labreche, Kaeffer, and Testart) and Digestive Physiology (Dr Denis), Hôpital Charles Nicolle, Rouen, France.

Arch Surg. 1994;129(8):814-818. doi:10.1001/archsurg.1994.01420320036006
Abstract

Objective:  To assess whether careful dissection and isolation of vagus nerves from the three-quarter Nissen fundoplication wrap (a periesophageal posterior gastric wrap 270° in circumference) could modify the postoperative outcome and reduce postoperative gastric emptying disturbances.

Design:  Open randomized control trial.

Setting:  University hospital.

Patients:  Forty-two patients with proved esophageal reflux and indication for surgery, after informed consent.

Interventions:  A three-quarter Nissen fundoplication with (21 cases) or without (21 cases) dissection and exclusion of vagus nerves from the wrap.

Main Outcome Measures:  Standard questionnaire, acid reflux test, and gastric emptying study before and 3 months after surgery.

Results:  No difference was found between the groups. There was a correlation between preoperative and postoperative gastric emptying.

Conclusion:  Exclusion of the vagus nerves from the three-quarter Nissen fundoplication wrap provides no advantage on postoperative gastric emptying and does not affect outcome of reflux surgery.(Arch Surg. 1994;129:814-818)

References
1.
Demeester TR, Johnson LF, Kent AH.  Evaluation of current operations for the prevention of gastroesophageal reflux . Ann Surg . 1974;180:511-539.Article
2.
Segol P, Hay JM, Pottier D.  Traitement chirurgical du reflux gastro-oesophagien: quelle intervention choisir: Nissen, Toupet, ou Lortat Jacob? essai multicentrique par tirage au sort . Gastroenterol Clin Biol . 1989;13:873-879.
3.
Thor KBA, Silander F.  A long term randomized prospective trial of the Nissen procedure versus a modified Toupet technique . Am Surg . 1989;210:719-724.
4.
Demeester TR, Bonavina L, Albertucci M.  Nissen fundoplication for gastroesophageal reflux disease: evaluation of primary repair in 100 consecutive patients . Ann Surg . 1986;204:9-20.Article
5.
Guarner V.  Ten years evaluation of posterior fundoplasty in the treatment of gastroesophageal reflux . Am J Surg . 1980;13:200-203.Article
6.
Negre JB.  La fundoplicature de Nissen: echecs et inconvénients à long terme . Ann Chir . 1984;38:275-280.
7.
Stanghellini V, Malagelada JR.  Gastric manometric abnormalities in patients with dyspeptic symptoms after fundoplication . Gut . 1983;24:790-797.Article
8.
Behar J, Rambsy G.  Gastric emptying and antral motility in reflux esophagitis: effect of oral metoclopramide . Gastroenterology . 1978;74:253-256.
9.
Malagelada JR, Rees WDW, Mazzotta LJ, Go ULW.  Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and Betanechol . Gastroenterology . 1980;79:311-314.
10.
Hinder RA, Stein HJ, Bremner CG, Demeester TR.  Relationship of satisfactory outcome to normalization of delayed gastric emptying after Nissen fundoplication . Ann Surg . 1989;210:458-464.Article
11.
Jian R.  Reflux gastro-oesophagien et matricité gastrique . Gastroenterol Clin Biol . 1986;10:319-321.
12.
Schwizer W, Hinder RA, Demeester TR.  Does delayed gastric emptying contribute to gastroesophageal reflux disease? Am J Surg . 1989;157:74-81.Article
13.
McCallum RW, Berkowitz DM, Lerner E.  Gastric emptying in patients with gastroesophageal reflux . Gastroenterology . 1981;80:285-291.
14.
Herrington JL, Meacham PW, Hunter RM.  Gastric ulceration after fundic wrapping: vagal nerve entrapment a possible causative factor . Ann Surg . 1982:195: 574-581.Article
15.
Galmiche JP, Guillard JF, Denis P, Boussakr K, Lefrancois R, Colin R.  Etude du pH oesophagien en péroide post prandiale chez le sujet normal et au cours du syndrome de reflux gastro-oesophagien: intérêt diagnostique d'un score de reflux acide . Gastroenterol Clin Biol . 1980;4:531-539.
16.
Savary M, Miller G.  The esophagus . In: Handbook and Atlas of Endoscopy . Westbury, NY: Solothurn Gassman; 1978:135-139.
17.
Drossman DA, Thompson WG, Talley NJ, Funch-Jensen P, Janssens J, Whitehead WE.  Identification of sub-groups of functional gastrointestinal disorders . Gastroenterology Int . 1990;3:159-172.
18.
Kaye MD.  Postprandial gastroesophageal reflux in healthy people . Gut . 1977; 18:709-712.Article
19.
Fink SM, McCallum RW.  The role of prolonged esophageal pH monitoring in the diagnosis of gastroesophageal reflux . JAMA . 1984;252:1160-1164.Article
20.
Bertrand J, Metman EH, Danchequin Dorval E, et al.  Etude du temps d'évacuation gastrique des repas normaux au moyen de granules radio-opaque: applications cliniques et validation . Gastroenterol Clin Biol . 1980;4:770-776.
21.
Velasco N, Hill D, Gannan RM, Pope CW.  Gastric emptying and gastroesophageal reflux: effects of surgery and correlation with esophageal motor function . Am J Surg . 1982;144:58-62.Article
22.
Shay SS, Egi D, McDonald C, Johnson LF.  Gastric emptying of solid food in patients with gastroesophageal reflux . Gastroenterology . 1987;92:459-465.
23.
Maddern GJ, Chatterton BE, Collins PJ, Horowitz M, Shearman DJC, Jamieson GG.  Solid and liquid gastric emptying in patients with gastroesophageal reflux . Br J Surg . 1985;72:344-347.Article
24.
Maddern GJ, Jamieson GG.  Fundoplication enhances gastric emptying . Ann Surg . 1985;201:296-299.Article
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