The Effect of Adding Pyloroplasty to Nissen Fundoplication in Improving the Outcome in Patients with Delayed Gastric Emptying Associating Gastro Esophageal Reflux Disease: A Meta-Analysis

Abstract

Abstract Background An important consideration for patients with GERD is the possibility of underlying gastroparesis defined as delayed gastric emptying in the absence of mechanical obstruction. The addition of a pyloroplasty to nissen fundoplication in patients with GERD is said to improve bloating symptoms and promote faster gastric emptying. Aim of the Work The aim of this meta-analysis study is to identify the effect of adding pyloroplasty to Nissen Fundoplication in improving the outcome in patients with delayed gastric emptying associating Gastro esophageal reflux disease. Patients and Methods Types of studies used Published studies about the effect of adding pyloroplasty to Nissen Fundoplication in improving the outcome in patients with delayed gastric emptying associating Gastro esophageal reflux disease (carried out in the period between 2000 – 2020). The published English-language literature was searched in the databases PUBMED (US National Library of Medicine, Bethesda, Maryland) (2000 to present), EMBASE (Reed Elsevier PLC, Amsterdam, Netherlands) (2000 to present), as well as Google Scholar and Science direct. The search terms was employed: “Pyloroplasty” and “Delayed gastric emptying” or “gastroparesis” and “Nissen’s fundoplication”. Results A total of four studies reported there was statistically significant decrease in the T1/2 postoperative (90.62 ± 15.64) than preoperative (192.42 ± 28.10) with p-value <0.001. The change from pre to postoperative t ½ with a total sample size of 164 patients. The overall effect estimates noted a significant reduction in the t ½ by 116.5 (95% CI 85.9 – 146.9) minutes. The pooled effect estimates showed significant heterogeneity (p = 0.016; I2 =71%). A total of four studies reported the rate of symptomatic improvement with a total sample size of 164 patients. The overall effect estimates noted a symptomatic improvement rate by 84% (95% CI 78.6 – 89.7%). The pooled effect estimates showed no significant heterogeneity (p = 0.66; I2 =0%). Conclusion Laparoscopic pyloroplasty with Nissen’s fundoplication is an effective procedure and might be considered as a first-line treatment for selected cases of gastroparesis. We report an 84% symptomatic improvement rate and 71% improvement rate for gastric emptying times measured by scintigraphy. The procedure can be performed with a minimally invasive technique with low morbidity and no mortality. The laparoscopic approach does not preclude subsequent procedures when required.