The Impact of Delayed Gastric Emptying on Outcome of Nissen Fundoplication in GERD Patients
Weisheng Chen, Steven R. Demeester, Shahin Ayazi*, Gaurav Sharma, Joerg Zehetner, Kimbely S. Grant, Florian Augustin, Daniel S. OH, John C. Lipham, Jeffrey a. Hagen, Tom R. Demeester
Surgery, University of Southern California, Los Angeles, CA
Background: Symptoms of delayed gastric emptying are common in patients with gastroesophageal reflux disease (GERD). The aim of this study was to compare symptomatic outcome after Nissen fundoplication in patients with and without delayed gastric emptying symptoms (DGES).Patients and methods: Records from 650 patients who had a primary Nissen fundoplication for proven GERD from 2002-2008 were reviewed, and patients with symptoms of delayed gastric emptying (nausea, early or prolonged satiety) were identified. A comparison group of age and sex matched patients who had primary antireflux surgery during the same period for proven GERD but without symptoms of delayed gastric emptying was also identified. Outcome after surgery was compared between groups, and a favorable symptomatic outcome was defined as either complete relief of all preoperative symptoms without troublesome new symptoms, or residual symptoms occurring less than once a month.Results: Preoperative symptoms of delayed gastric emptying were present in 140 patients: 60 had a normal gastric emptying study (DGES: Normal study), 31 had either an abnormal gastric emptying study (n=22) or retained food in the stomach on endoscopy after an overnight fast (n=9) (DGES: Abnormal study), and 49 had no gastric emptying study performed (DGES: No study). The comparison group (No DGES) consisted of 140 patients. A Nissen fundoplication was performed in all patients, and in 17 of 31 patients in the DGES: Abnormal study group a gastric drainage procedure was added. Demographic data, preoperative pH and manometry values, and mean follow up were similar between groups. Delayed gastric emptying symptoms were relieved in 91% of patients, but a favorable surgical outcome was significantly less likely in patients with DGES [Table]. The majority of unsatisfactory results in DGES patients were due to persistent symptoms of delayed gastric emptying. Relief of reflux symptoms was similar. The addition of a drainage procedure did not increase the likelihood of a favorable surgical outcome (70.6% vs. 71.4%, p=1).Conclusions: Patients with GERD and delayed gastric emptying symptoms are less likely to have a favorable symptomatic outcome after Nissen fundoplication compared to GERD patients without delayed gastric emptying symptoms, despite similar relief of reflux symptoms. The addition of a drainage procedure in patients with proven delayed gastric emptying did not improve the symptomatic outcome.
| No DGES(comparison group)(n=140) | DGES,No study(n=49) | DGES,Normal study(n=60) | DGES,Abnormal study(n=31) | p value | |
| Favorable symptomatic outcome (%) | 127(90.7%) | 37(75.6%) | 45(75%) | 22(70.1%) | 0.004 |
| Reflux symptom control (%) | 132(94.3%) | 44(89.8%) | 54(94.7%) | 15 (88.2%) | 0.57 |
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