Outcomes of Nissen Fundoplication in Patients With Gastroesophageal Reflux Disease and Delayed Gastric Emptying | Bariatric Surgery | JAMA Surgery | JAMA Network
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September 21, 2009

Outcomes of Nissen Fundoplication in Patients With Gastroesophageal Reflux Disease and Delayed Gastric Emptying

Author Affiliations

Author Affiliations: Minimally Invasive Surgery Division, Legacy Heath System, Portland, Oregon.

Arch Surg. 2009;144(9):823-828. doi:10.1001/archsurg.2009.160

Objective  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.

Design  Retrospective analysis of prospectively collected data.

Setting  Tertiary care teaching hospital.

Patients  A total of 141 consecutive patients considered for Nissen fundoplication who also had suspected DGE based on symptoms.

Interventions  Of 141 patients, 63 had a time to 50% emptying (T½) greater than 90 minutes; 47 of the 63 of these had severe DGE (T½ > 150 minutes) and had Nissen fundoplication and pyloroplasty. Sixteen of the 141 with T½ 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).

Results  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, T½ 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).

Conclusions  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.