Objective
To study the effect of Nissen fundoplication on the pattern of gastric empt
ying and intragastric distribution of symptoms in patients with normal and
delayed gastric emptying before surgery, especially in those with delayed e
mptying before surgery.
Summary Background Data
Gastroesophageal reflux disease is associated with delayed gastric emptying
and dyspeptic symptoms in approximately 40% of the patients. After Nissen
fundoplication, dyspeptic symptoms are also not uncommon.
Methods
Thirty-six patients (26 men, 10 women, mean age 43.1) were studied before a
nd 3 months after Nissen fundoplication. Gastric emptying (dual-isotope, ex
pressed in lag phase, emptying rate, T-50, and intragastric distribution) w
as not included in the decision for surgery. Reflux-related and dyspeptic s
ymptoms were scored before and at 3, 6, and 12 months after surgery.
Results
Twenty-six patients had normal and 10 had delayed gastric emptying before s
urgery. Nissen fundoplication on average enhanced gastric emptying for soli
ds in both subgroups by a combination of a decrease in mean lag phase, empt
ying rate, and T-50. The preoperative difference in intragastric distributi
on between patients with and without delayed gastric emptying was abolished
by fundoplication. Patients with normal gastric emptying before surgery sh
owed an increase in early postprandial satiety; in those with delayed empty
ing, this was not observed. A correlation was found between preoperative To
for liquid gastric emptying and postoperative nausea at 3 months in patien
ts with normal gastric emptying. In patients with delayed emptying, preoper
ative correlations between lag phase for liquids and nausea respectively ea
rly satiety were significant, as well as for T-50 for liquids and vomiting.
Conclusions
Nissen fundoplication equalizes the preoperative difference in intragastric
distribution and accelerates gastric emptying without an effect on symptom
s in patients with preexisting delayed gastric emptying, but with an increa
se in early satiety in patients with normal gastric emptying. Delayed gastr
ic emptying is not a contraindication for antireflux surgery.