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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

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)