title: Preoperative liquid gastric emptying rate does not predict outcome after fundoplication.
abstract: OBJECTIVE
  Preoperative gastric emptying (GE) rate in patients with gastrointestinal reflux disease (GERD) was evaluated as a predictor of outcome after antireflux surgery.
  
  
  METHODS
  GE was assessed using radionuclide scintigraphy and a standardized meal with cow's milk. GE half time (T1/2), patient demographics and GERD symptoms including vomiting (>4days/week), retching (>4days/week), prolonged feeding time (>3h/day), and discomfort after meals were recorded pre- and postoperatively. A standardized follow-up included a 24-h pH-monitoring and an upper gastrointestinal contrast study. Of 74 patients undergoing Nissen fundoplication between 2003 and 2009, 35 underwent a preoperative GE study. The remaining 39 patients were not examined owing to volume intolerance, cow's milk intolerance or allergy, inability to lie still, or parents refusing participation.
  
  
  RESULTS
  Median age at fundoplication was 4.9 [range 1.1-15.4] years, and follow-up time was median 4.3 [1.9-8.9] years. GERD recurred in 7 (20%) patients. Preoperative T1/2 in the seven patients with recurrent GERD was median 45 [21-87] min compared to 44 [16-121] min in the 28 patients without recurrent GERD (p=0.92). There was no significant difference between the one third of patients with the slowest GE [T1/2 54-121min] and the remaining patients [T1/2 16-49min] regarding GERD recurrence or postoperative vomiting, retching, prolonged feeding time, or discomfort after meals.
  
  
  CONCLUSIONS
  Preoperative GE rate did not predict outcome after antireflux surgery, as slow GE was not associated with recurrent GERD or postoperative troublesome symptoms such as vomiting, retching, or meal discomfort.
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway; Department of Pediatrics, Oslo University Hospital, Norway. Electronic address: charlotte@knatten.org.
authors.forename: C K
authors.initials: CK
authors.lastname: Knatten
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway; Oslo and Akershus University College of Applied Sciences.
authors.forename: J G
authors.initials: JG
authors.lastname: Fjeld
authors.affiliation: Department of Gastroenterology, Oslo University Hospital, Norway.
authors.forename: A W
authors.initials: AW
authors.lastname: Medhus
authors.affiliation: Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital, Norway.
authors.forename: A H
authors.initials: AH
authors.lastname: Pripp
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway.
authors.forename: T J
authors.initials: TJ
authors.lastname: Fyhn
authors.affiliation: Department of Gastroenterology, Oslo University Hospital, Rikshospitalet, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Aabakken
authors.affiliation: Department of Radiology and Nuclear Medicine, Oslo University Hospital, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Kjosbakken
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Norway; Intervention Centre, Oslo University Hospital, Rikshospitalet, Norway; Department of HPB Surgery, Oslo University Hospital, Rikshospitalet, Norway.
authors.forename: B
authors.initials: B
authors.lastname: Edwin
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: R
authors.initials: R
authors.lastname: Emblem
authors.affiliation: Department of Gastrointestinal and Pediatric Surgery, Oslo University Hospital, Norway; Institute of Clinical Medicine, University of Oslo, Norway.
authors.forename: K
authors.initials: K
authors.lastname: Bjørnland
mesh_terms: D000293:Adolescent; D000818:Animals; D002648:Child; D002675:Child, Preschool; D005260:Female; D018662:Fundoplication / Q000379:methods; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000503:physiopathology* / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008892:Milk; D011183:Postoperative Complications; D011184:Postoperative Period; D057234:Preoperative Period; D011446:Prospective Studies; D011877:Radionuclide Imaging; D012008:Recurrence; D016896:Treatment Outcome
keywords: Fundoplication; GER; GERD; Gastric emptying; Scintigraphy