Effect of Nissen fundoplication on gastric motor and sensory functions.
OBJECTIVE
Bloating, abdominal pain, and early satiety have been reported in up to 30% of patients after Nissen fundoplication. We hypothesized that these postsurgical complications in children and young adults are linked to either the effects of surgery on gastric sensation, compliance or motor function or to preexisting physiological abnormalities.


METHODS
We prospectively evaluated the effect of Nissen fundoplication on gastric sensory and motor functions in 13 children with gastroesophageal reflux. Gastric barostat and mixed meal gastric emptying studies were performed before surgery in all patients and were repeated after surgery in 8 and 9 children, respectively.


RESULTS
Thirteen patients (median age, 7 years; range, 6 months to 18 years) underwent open Nissen (n = 6) or laparoscopic Nissen fundoplication (n = 7). After fundoplication, patients had significantly higher minimal distending pressure values (10 mm Hg vs 3 mm Hg pre-Nissen, respectively; P < 0.001), reduced gastric compliance (slope values of 8.39 mm Hg vs 9.15 mm Hg, respectively, P < 0.001) and significantly higher pain scores (P < 0.001). Presurgery and postsurgery gastric emptying at 60, 90 and 120 minutes after feeding showed no significant changes.


CONCLUSIONS
After Nissen fundoplication, children with gastroesophageal reflux manifest the following: (1) reduction in gastric compliance, (2) increase in minimal gastric distending pressure, (3) exacerbation of the sensations discomfort with gastric distension and (4) no effect on gastric emptying.
Mousa
Hayat
H
Division of Gastroenterology, Department of Pediatrics, The Ohio State University College of Medicine and Public Health, Columbus, USA. mousah@pediatrics.ohio-state.edu
Caniano
Donna A
DA
Alhajj
Maya
M
Gibson
Laurie
L
Di Lorenzo
Carlo
C
Binkowitz
Larry
L
D015746:Abdominal Pain / Q000453:epidemiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004435:Eating; D005260:Female; D018662:Fundoplication / Q000009:adverse effects / Q000379:methods; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D011312:Pressure; D011446:Prospective Studies; D012677:Sensation / Q000502:physiology*