title: Gastric emptying and antireflux surgery.
abstract: OBJECTIVE
  Absence of consistent data on the outcome of gastric emptying after fundoplication raises concerns about preoperative workup and surgical management. This study assessed how gastric emptying evolves after isolated fundoplication in order to determine whether a preoperative investigation and/or a concurrent gastric drainage procedure are justified.
  
  
  METHODS
  Eleven children with GERD underwent both pre- and post-operative gastric emptying scintigraphy. No gastric drainage procedures were added to fundoplication. Scintigraphy was performed according to a standardized protocol (labeled meal, 300 ml + 500 μCi (99m)Tc/m(2) bsa). Half-emptying time (t (1/2)), emptying rate and fractions of retention are expressed as the median followed by the [range]; statistical significance level was set at 5%.
  
  
  RESULTS
  Postoperative t (1/2) (min) showed a much smaller dispersion and was significantly lower than preoperative one (76 [56;101] vs. 107 [57;186], p = 0.04) with a variation of -48 [-105;19]; there was no individual correlation between pre- and post-operative measurements (r = 0.25). The proportion of patients with delayed gastric emptying (t (1/2) > 100) was significantly lower in the postoperative scintigraphy (9 vs. 55%, p = 0.03). The postoperative emptying rate (%/h) was significantly faster (35.1 [18.9;41.7] vs. 28.5 [16.3;38.7], p = 0.05). The retentions (%) at 30 and 60 min were similar; at 90 and 120 min were significantly lower after surgery (45 [35;54] and 32 [24;46] vs. 53 [33;78] and 41 [25;66], p = 0.03 and 0.05).
  
  
  CONCLUSIONS
  Gastric emptying accelerates significantly after fundoplication with a shift to normal values in the vast majority of patients. Scintigraphy does not predict the postoperative outcome. Therefore, concomitant drainage procedures seem unnecessary and preoperative gastric emptying study not useful.
authors.affiliation: Division of Pediatric Surgery, Faculty of Medicine of Porto, Hospital S. João, Porto, Portugal. estevao.costa@hsjoao.min-saude.pt
authors.forename: José
authors.initials: J
authors.lastname: Estevão-Costa
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Fragoso
authors.forename: Maria José
authors.initials: MJ
authors.lastname: Prata
authors.forename: Miguel
authors.initials: M
authors.lastname: Campos
authors.forename: Eunice
authors.initials: E
authors.lastname: Trindade
authors.forename: Jorge Amil
authors.initials: JA
authors.lastname: Dias
authors.forename: Ana Maria
authors.initials: AM
authors.lastname: Brazão
mesh_terms: D000704:Analysis of Variance; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D008297:Male; D011184:Postoperative Period; D057234:Preoperative Period; D011877:Radionuclide Imaging; D018709:Statistics, Nonparametric; D016896:Treatment Outcome