Prospective study of the effect of laparoscopic hemifundoplication on motor and sensory function of the proximal stomach

Background: Some 30 per cent of patients develop dyspeptic symptoms followi ng antireflux surgery, These symptoms may result from alterations in the mo tor and sensory function of the proximal stomach. Methods: Proximal gastric motor and sensory function was studied with an el ectronic barostat in 12 patients with reflux who underwent laparoscopic hem ifundoplication, In addition, 24-h pHmetry, gastric emptying (scintigraphy) and vague nerve integrity (pancreatic polypeptide response to hypoglycaemi a) were assessed. Fifteen healthy volunteers served as controls. Results: Laparoscopic hemifundoplication significantly decreased total acid exposure rime (P<0.05). Vagus nerve function remained intact in all hut on e patient. The mean(s.e.m) lag phase for emptying of solids was significant ly shorter after operation than before (15(3) versus 21(3) min; P<0.05), Pr oximal gastric compliance was not significantly different before and after fundoplication, However, mean(s.e.m.) postprandial relaxation was significa ntly reduced (P<0.05) after hemifundoplication compared with the value befo re operation (3341(1105) versus 12 763(3616)nil over 90 min) and in control s (14 567(2358) ml over 90 min). Postprandial fullness was significantly in creased after hemifundoplication (P<0.05). Postprandial gastric relaxation correlated with the lag phase for emptying of solids (r=0.55, P<0.02). Conclusion: After hemifundoplication, proximal gastric compliance is not al tered but postprandial relaxation is impaired and associated with sensation s of fullness and shorter duration of the lag phase for emptying of solids.