Preoperative gastric emptying and patterns of reflux as predictors of outcome after laparoscopic fundoplication.
BACKGROUND
Some studies have suggested that patients with predominantly upright reflux have a poor outcome after laparoscopic antireflux surgery. It has been proposed that this might be related to gastric emptying. The aim of this study was to evaluate the relationship between preoperative upright reflux pattern, gastric emptying rate and outcome after laparoscopic fundoplication.


METHODS
Patients presenting for antireflux surgery underwent 24-h ambulatory pH testing and dual-isotope radionuclide gastric emptying studies. Reflux pattern was determined by the acid exposure in the distal oesophagus (percentage of time at pH < 4) during supine and upright posture. Outcome after fundoplication was assessed by a standardized postal questionnaire administered at 3 months, and 1, 2 and 5 years after surgery.


RESULTS
Of 372 patients identified from a prospectively maintained database, 109 had upright reflux, 57 supine reflux and 206 bipositional reflux. Overall patient satisfaction was not influenced by reflux pattern at any time after surgery. Delayed gastric emptying was documented in 31.0 per cent of patients, but there was no relationship with reflux pattern.


CONCLUSIONS
Patients with upright reflux did not have a less favourable outcome after fundoplication. Categorizing patients according to reflux pattern is of no value in predicting outcome or selecting patients for surgery.
Wayman
J
J
University of Adelaide Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Myers
J C
JC
Jamieson
G G
GG
D000328:Adult; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000209:etiology / Q000503:physiopathology*; D011237:Predictive Value of Tests; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D016896:Treatment Outcome