title: Effect of Vagus Nerve Integrity on Short and Long-Term Efficacy of Antireflux Surgery.
abstract: Vagus nerve injury is a feared complication of antireflux surgery (ARS) that may negatively affect reflux control. The aim of the present prospective study was to evaluate short-term and long-term impact of vagus nerve injury, evaluated by pancreatic polypeptide response to insulin-induced hypoglycemia (PP-IH), on the outcome of ARS.
  
  
  
  In the period from 1990 until 2000, 125 patients with gastroesophageal reflux disease (GERD) underwent ARS at a single center. Before and 6 months after surgery, vagus nerve integrity testing (PP-IH), 24-h pH-monitoring, gastric emptying, and reflux-associated symptoms were evaluated. In 2014, 14-25 years after surgery, 110 patients were contacted again for evaluation of long-term symptomatic outcome using two validated questionnaires (Gastrointestinal Symptom Rating Scale (GSRS) and GERD-Health Related Quality of Life (HRQL)).
  
  
  
  Short-term follow-up: vagus nerve injury (PP peak ≤47 pmol/l) was observed in 23 patients (18%) 6 months after fundoplication. In both groups, a comparable decrease in reflux parameters and symptoms was observed at 6-month follow-up. Postoperative gastric emptying was significantly delayed in the vagus nerve injury group compared with the vagus nerve intact group. Long-term follow-up: patients with vagus nerve injury showed significantly less effective reflux control and a higher re-operation rate.
  
  
  
  Vagus nerve injury occurs in up to 20% of patients after ARS. Reflux control 6 months after surgery was not affected by vagus nerve injury. However, long-term follow-up showed a negative effect on reflux symptom control and re-operation rate in patients with vagus nerve injury.
authors.affiliation: Division of Gastroenterology-Hepatology, NUTRIM Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.|Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: S
authors.initials: S
authors.lastname: van Rijn
authors.affiliation: Division of Gastroenterology-Hepatology, NUTRIM Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: N F
authors.initials: NF
authors.lastname: Rinsma
authors.affiliation: Department of Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
authors.forename: M Y A
authors.initials: MY
authors.lastname: van Herwaarden-Lindeboom
authors.affiliation: Department of General Surgery, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Ringers
authors.affiliation: Department of OR/Evidence Based Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
authors.forename: H G
authors.initials: HG
authors.lastname: Gooszen
authors.affiliation: Department of General Surgery, Lange Land Hospital Zoetermeer, Zoetermeer, The Netherlands.
authors.forename: P J J
authors.initials: PJ
authors.lastname: van Rijn
authors.affiliation: Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: R A
authors.initials: RA
authors.lastname: Veenendaal
authors.affiliation: Division of Gastroenterology-Hepatology, NUTRIM Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Conchillo
authors.affiliation: Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: N D
authors.initials: ND
authors.lastname: Bouvy
authors.affiliation: Division of Gastroenterology-Hepatology, NUTRIM Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Adrian A M
authors.initials: AA
authors.lastname: Masclee
mesh_terms: D000328:Adult; D000368:Aged; D050782:Esophageal pH Monitoring; D005260:Female; D018662:Fundoplication; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000601:surgery*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis*; D011446:Prospective Studies; D011788:Quality of Life; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D061223:Vagus Nerve Injuries / Q000175:diagnosis*