Long-term Gastrointestinal Symptoms After Laparoscopic Nissen Fundoplication

Beldi, Guido; Glättli, A

doi:10.1097/00129689-200210000-00002

Cited by 26 publications

(17 citation statements)

References 17 publications

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“…It is well known that postoperative gas/bloating and diarrhea can be troublesome and persistent for patients undergoing laparoscopic antireflux surgery [3,4]. Our results confirm this, because the incidences of gas/ bloating and diarrhea were significantly increased in the non-IBS group postoperatively.…”

Section: Discussionsupporting

confidence: 87%

Clinical outcome of Laparoscopic antireflux surgery for patients with irritable bowel syndrome

et al. 2004

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Section: Discussionsupporting

confidence: 87%

Clinical outcome of Laparoscopic antireflux surgery for patients with irritable bowel syndrome

et al. 2004

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“…Previous studies have examined the spectrum of gastrointestinal symptoms after fundoplication in the short term and noted that the majority of patients exhibit some gastrointestinal side effects, such as early satiety and dysphagia, in the immediate postoperative period [15]. The results of this LOSP, lower esophageal sphincter resting pressure study correspond with those of a French study [6] and one from Switzerland [2] and show that flatulence was the most prevalent of all functional symptoms (66% of patients with at least moderate severity) in the long term. More important, it was the only symptom that significantly worsened overall in both severity and frequency as a result of surgery.…”

Section: Discussionsupporting

confidence: 70%

Changes in functional gastrointestinal symptoms as a result of antireflux surgery

2005

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“…In an extensive review by Beldi et al of postoperative gastrointestinal symptoms after open or laparoscopic fundoplication, 12-88% of patients complained of flatulence, 17-100% of early satiety and fullness, and 15-56% of meteorism [1]. In an unpublished review of several hundred patients from our institution, 51% complained of increased abdominal cramping and bloating which was severe in only 6%.…”

Section: Commentmentioning

confidence: 86%

Gastric emptying and vagus nerve function after laparoscopic partial fundoplication

Bremner

2005

Eur Surg

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The aim of this study was to assess the impact of inadvertent vagotomy during laparoscopic fundoplication on symptoms and gastric function.This was a prospective study of vagal integrity using pancreatic polypeptide (PP) response to insulin hypoglycemia and the effect of denervation on gastric emptying.Four of 41 patients studied 3 to 6 months after surgery had a polypeptide response suggesting vagal denervation. Gastric emptying in these patients was not influenced by the alleged denervation. Furthermore, there was no correlation between symptoms and gastric emptying data. The authors conclude that vagus nerve denervation does not adversely affect the success of antireflux surgery. CommentThis was a well constructed study, and investigations were completed in all patients. It is the first study to assess the effect of laparoscopic antireflux surgery on gastric emptying in relation to vagus nerve function.Laparoscopic antireflux surgery gives excellent control of reflux symptoms, but in many patients new symptoms of diarrhea, epigastric discomfort, fullness, early satiety, and gas bloat may be present.In an extensive review by Beldi et al. of postoperative gastrointestinal symptoms after open or laparoscopic fundoplication, 12-88% of patients complained of flatulence, 17-100% of early satiety and fullness, and 15-56% of meteorism [1]. In an unpublished review of several hundred patients from our institution, 51% complained of increased abdominal cramping and bloating which was severe in only 6%. With time, these symptoms improved in 38% and resolved in 14%. Despite these symptoms, 95% were satisfied with the results of surgery.The altered physiology responsible for these symptoms has not been well studied. Barostat studies, previously reported from the team at Leiden University, have demonstrated an impairment of postprandial relaxation of the proximal stomach associated with sensations of fullness and a shorter duration of the lag phase of gastric emptying [2]. Abdominal discomfort after fundoplication could therefore also be related to an increase in the rate of gastric emptying following the operation. Generally, delayed gastric emptying is normalized after fundoplication, as was reported by our group in 1989 [3], and again in the study under discussion. This is regarded as a beneficial effect in patients with initial delayed gastric emptying, and as the authors point out, delayed gastric emptying is not a contraindication to fundoplication. We have not addressed the possibility that fundoplication may exacerbate an already increased rate of emptying.In patients with these persistent symptoms after surgery, the possibility of inadvertent vagotomy during surgery has also to be considered, and the authors address this possibility. Proof of the vagotomy following surgery has always been difficult to establish, and the effect on gastric function is not well documented.Historically, vagal function has been assessed by gastric acid secretion stimulated by pentagastrin and histamine, a high gastric pH, increased seru...

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Long-term Gastrointestinal Symptoms After Laparoscopic Nissen Fundoplication

Cited by 26 publications

References 17 publications

Clinical outcome of Laparoscopic antireflux surgery for patients with irritable bowel syndrome

Clinical outcome of Laparoscopic antireflux surgery for patients with irritable bowel syndrome

Changes in functional gastrointestinal symptoms as a result of antireflux surgery

Gastric emptying and vagus nerve function after laparoscopic partial fundoplication

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