title: Nissen fundoplication improves gastric motility in patients with delayed gastric emptying.
abstract: BACKGROUND
  Fundoplication hastens gastric emptying in pediatric patients with gastroesophageal reflux disease (GERD). However, among adult GERD patients with impaired gastric emptying, the degree of improvement offered by fundoplication and the value of pyloroplasty are less well defined. Therefore, we compared outcomes in GERD patients with delayed gastric emptying after fundoplication alone or fundoplication with pyloroplasty.
  
  
  METHODS
  Of 616 consecutive GERD patients who submitted to primary fundoplication (601 laparoscopic) between October 1991 and October 1997, 82 underwent preoperative solid-phase nuclear gastric emptying analysis. Of these, 25 had delayed gastric emptying (half-time >100 min). Of 12 patients with emptying half-times between 100 and 150 min, one underwent pyloroplasty at the time of Nissen fundoplication. Of 13 patients with emptying half-times >150 min, 11 had pyloroplasty at the time of Nissen fundoplication. Patients were asked to use a 0 ("none") to 4 ("incapacitating") scale to describe the severity of their symptoms of heartburn, regurgitation, dysphagia, bloating and diarrhea preoperatively and at 6 weeks and 1 year postoperatively. Eight patients consented to a postoperative analysis of gastric emptying.
  
  
  RESULTS
  One year after fundoplication, patients with delayed gastric emptying and controls reported a similar improvement in heartburn, regurgitation, and dysphagia, with no increase in undesirable side effects such as bloating and diarrhea. Among the patients with delayed gastric emptying who consented to undergo a repeat gastric emptying study after their operation, fundoplication alone provided a 38% improvement (p < 0.05) in gastric emptying, whereas fundoplication with pyloroplasty resulted in a 70% improvement in gastric emptying (p < 0.05).
  
  
  CONCLUSIONS
  Fundoplication improves gastric emptying. The addition of pyloroplasty results in even greater improvement and may have particular value for patients with severe gastric hypomotility.
authors.affiliation: Department of Surgery, Emory University School of Medicine, 1364 Clifton Rd., N, Atlanta, GA 30322, USA. tfarrell@med.unc.edu
authors.forename: T M
authors.initials: TM
authors.lastname: Farrell
authors.forename: W S
authors.initials: WS
authors.lastname: Richardson
authors.forename: R
authors.initials: R
authors.lastname: Halkar
authors.forename: C P
authors.initials: CP
authors.lastname: Lyon
authors.forename: K D
authors.initials: KD
authors.lastname: Galloway
authors.forename: J P
authors.initials: JP
authors.lastname: Waring
authors.forename: C D
authors.initials: CD
authors.lastname: Smith
authors.forename: J G
authors.initials: JG
authors.lastname: Hunter
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology / Q000601:surgery*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000503:physiopathology / Q000601:surgery; D012720:Severity of Illness Index; D016896:Treatment Outcome