Abnormal Gastric Emptying is Common After Nissen Fundoplication

Abstract

Introduction: Surgical fundoplication is often performed for gastroesophageal (GERD) symptoms not fully responsive to anti-secretory therapy; however, a subset of patients develop gas/bloat and dyspeptic symptoms following surgery. The effects on gastric motility following surgical fundoplication are poorly documented. A few proposed mechanisms have included impaired post-prandial fundic accommodation and vagal nerve injury. The aim of this study is to analyze the effect of Nissen fundoplication on gastric emptying. Methods: Patients who underwent Nissen fundoplication at Cleveland Clinic between March 2001 to December 2013 and had both pre- and post-operative gastric emptying scintigraphy (GES) available were reviewed. GES was performed using the standardized protocol of oral ingestion of 1 millicuries of 99m technetium sulfur colloid mixed with a standardized egg meal followed by imaging over the abdomen being obtained in the anterior and posterior projections at 0, 1, 2 and 4 hours post ingestion. Patients with less than 30% gastric retention at 1 hour were recognized as having rapid gastric emptying; retention of >10% at four hours were diagnosed with gastroparesis. Data were analyzed using SPSS version 20 (SPSS Inc, Chicago, IL). Continuous variable were expressed as means and standard deviation and categorical variables expressed as percentages.Table: Table. Change in gastric emptying post Nissen FundoplicationResults: 97 patients were included for review. Prior to surgery, 70 patients had normal emptying, 20 with delayed and 5 with rapid gastric emptying. The clinical profiles and surgical variables of these patients are detailed in Table 1. Our review revealed a significant increase in the number of patients with abnormal gastric emptying post-surgery, with the increase in gastroparesis from 22.7 to 32.0% and rapid gastric emptying from 5.2 to 10.3%.Table: Table. Patient characteristics at the time of Nissen FundoplicationConclusion: In patients with dyspeptic symptoms following Nissen fundoplication, both delayed and rapid gastric emptying must be considered as a potential etiology. In this study, 42.3% of patients had abnormal gastric emptying after fundoplication, compared to 28% before surgery. Further research is warranted regarding the pathophysiology and treatment of both rapid and delayed gastric emptying after fundoplication.