Nissen fundoplication improves gastric motility in patients with delayed gastric emptying

Background: Fundoplication hastens gastric emptying in pediatric patients w ith gastroesophageal reflux disease (GERD). However, among adult GERD patie nts with impaired gastric emptying, the degree of improvement offered by fu ndoplication and the value of pyloroplasty are less well defined. Therefore , we compared outcomes in GERD patients with delayed gastric emptying after fundoplication alone or fundoplication with pyloroplasty. Methods: Of 616 consecutive GERD patients who submitted to primary fundopli cation (601 laparoscopic) between October 1991 and October 1997, 82 underwe nt preoperative solid-phase nuclear gastric emptying analysis. Of these, 25 had delayed gastric emptying (half-time >100 min). Of 12 patients with emp tying half-times between 100 and 150 min, one underwent pyloroplasty at the time of Nissen fundoplication. Of 13 patients with emptying half-times >15 0 min, 11 had pyloroplasty at the time of Nissen fundoplication. Patients w ere asked to use a 0 ("none") to 4 ("incapacitating") scale to describe the severity of their symptoms of heartburn, regurgitation, dysphagia, bloatin g and diarrhea preoperatively and at 6 weeks and 1 year postoperatively. Ei ght patients consented to a postoperative analysis of gastric emptying. Results: One year after fundoplication, patients with delayed gastric empty ing and controls reported a similar improvement in heartburn, regurgitation , and dysphagia, with no increase in undesirable side effects such as bloat ing and diarrhea. Among the patients with delayed gastric emptying who cons ented to undergo a repeat gastric emptying study after their operation, fun doplication alone provided a 38% improvement (p < 0.05) in gastric emptying , whereas fundoplication with pyloroplasty resulted in a 70% improvement in gastric emptying (p < 0.05). Conclusion: Fundoplication improves gastric emptying. The addition of pylor oplasty results in even greater improvement and may have particular value f or patients with severe gastric hypomotility.