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Antireflux Surgery Enhances Gastric Emptying
Mikko Viljakka, MD;
Keijo Saali, MSc;
Matti Koskinen, PhD;
Lauri Karhumäki, MD;
Jyrki Kössi, MD;
Markku Luostarinen, MD;
Ossi Teerenhovi, MD;
Jouko Isolauri, MD
Arch Surg. 1999;134:18-21.
Objective To evaluate the influence of antireflux surgery on gastric emptying.
Design Nonrandomized controlled trial 3 months before and after surgical intervention.
Setting Secondary and tertiary referral center.
Patients and Control Subjects Twenty consecutive patients (7 women, 13 men), mean age 49.2 years, with symptomatic, objectively confirmed gastroesophageal reflux disease and 10 healthy control subjects (3 women, 7 men), mean age 37.3 years.
Intervention Laparoscopic or open Nissen fundoplication (in 1 case Toupet 180° posterior hemifundoplication).
Main Outcome Measures Gastric emptying scintigraphy, using solid food, in control subjects and patients 3 months before and 3 months after the operation; time to halving of the maximal activity and the activity remaining at 60, 100, and 120 minutes.
Results Preoperative symptoms included pyrosis in 19 of 20 patients and regurgitation in 18. Three months postoperatively, 19 patients were symptom-free. The mean time to halving of the maximal activity decreased from 113 to 78 minutes (P=.001). Delayed gastric emptying was found postoperatively in 3 patients, compared with preoperative values, using activity at 60, 100, 120 minutes and the mean time to halving of the maximal activity as the variables. Compared with control subjects, gastric emptying was slower in patients preoperatively and faster postoperatively, but the difference was not statistically significant.
Conclusion Gastric emptying is enhanced after antireflux surgery, along with cessation of symptoms and healing of esophagitis.
From the Department of Surgery, the Medical School, University of Tampere, Tampere (Dr Viljakka); the Departments of Clinical Physiology and Surgery, Kanta-Häme Central Hospital, Hämeenlinna (Mr Saali and Dr Karhumäki); the Departments of Clinical Physiology and Surgery, Tampere University Central Hospital, Tampere (Drs Koskinen, Luostarinen, and Teerenhovi); the Department of Surgery, Loimaa District Hospital, Loimaa (Dr Kössi); and Department of Surgery, Turku University Central Hospital, Turku (Dr Isolauri), Finland.
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