The effect of nissen fundoplication on gastric emptying and dyspeptic symptoms

Abstract

Dyspeptic symptoms are not uncommon after Nissen fundoplication, but whether delayed gastric emptying is a contraindication for Nissen fundoplication, with the risk of deterioration of these symptoms,is unertain. Aim: To study the effect of Nissen fundoplication on gastric emptying in patients with a normal and delayed gastric emptying. Methods: 36 patients (26m, IOf, mean age: 43.1) were studied before and 4 months after operation. Frequency and severity of dyspeptic symptoms were scored, from O(no symptoms)to 3(daily and severe). Gastric emptying studies were performed using a dual isotope technique. Results: 10 patients had delayed gastric emptying before operation that normalised in all but two after operation (TI/2: 390(440) vs. 82(29) min, p=0.05). Nissen fundoplication also enhanced gastric emptying of solids in patients with normal gastric emptying (TI/2: 115(21) vs. 83(24)min, p<O.OI). Heartbum and regurgitation were significantly reduced after operation for both groups (p<O.OI). Patients with a normal pre-operative gastric emptying showed a significant increase in early postprandial satiety (p<O.OI), flatulence (p=0.03) and a decrease in vomiting (p=O.03), while in patients with delayed gastric emptying these symptoms were not altered by operation. Other dyspeptic symptoms: belching and nausea were not affected by Nissen fundoplication (see table). No correlation was found between the presence of early satiety or nausea and gastric emptying rate. Conclusion: Nissen fundoplication accelerates gastric emptying without an effect on symptoms in patients with preexistent delayed gastric emptying, but with an increase in early satiety in patients with normal gastric emptying.