Background:The aims of this study were to:1) evaluate the clinical effectiveness of Nissen Fundoplication by comparing pre- and post-operative gastroesophageal reflux symptoms; 2) assess the effects of fundoplication on gastric emptying time (GET) and; 3) determine ifpre-operative gastric emptying could predict post-operative dyspeptic symptoms. Patients and Methods:27 patients (11M, 16F, mean age 47 years), underwent Nissen Fundoplication at KUMC by a single surgeon between November 1998 and September 2004. All patients had pre- and post-operative gastric emptying studies at which time a 255 kcal test meal consisting of Egg-Beaters prepared with 99m technetium sulfur colloid, 2 slices of bread, and one-half cup of water were consumed. Anterior and posterior images of the stomach were obtained immediately after eating , and again at 1 hour, 2, 3 and 4 hours to determine the percent of gastric retention. Patients also completed a survey which evaluated the severity of the following symptoms:heartburn, regurgitation, dysphagia, nausea, abdominal bloating, epigastric pain, fullness, early satiety, weight loss, diarrhea, constipation, and atypical chest pain (no symptoms = 0, Mild =1, Moderate = 2, Severe = 3). Results:The severity of all symptoms decreased post-operatively except for early satiety and weight loss.14 patients lost the ability to vomit. Pre-operative gastric emptying showed9/27 patients (33.3%) were slow compared to 8/27 (29.6%) post-operatively. Mean gastric retention of isotope at 4 hours was similar both pre- and post-operatively at 9.8% and 13.1% respectively. Those patients with a delayed GET pre-operatively experienced a 34.7% post-operative worsening of their dyspepsia symptoms:abdominal bloating, early satiety, fullness, weight loss and nausea. Conversely, those patients with a normal pre-operative GET experienced a 43.7% improvement in those 5 specific dyspepsia symptoms. Conclusions: 1) In patients who have failed standard medical management for GERD, Nissen Fundoplication is effective therapy.2) GET should be obtained both pre- and post-operatively so post-operative dyspepsia and gas-bloat syndrome can be interpreted.3) Delayed GET is not resolved by Nissen Fundoplication. 4) Dyspepsia symptoms could not reliably predict the subset of patients with pre-operative delayed GET, but post-operatively, increased dyspepsia occurred with delayed GET and could help explain the gas-bloat syndrome.