Outcomes of Nissen Fundoplication in Patients With Gastroesophageal Reflux Disease and Delayed Gastric Emptying

Objective: To investigate the effect of delayed gastric emptying (DGE) on subjective and objective outcomes of gastroesophageal reflux disease following Nissen fundoplication with or without pyloroplasty. Design: Retrospective analysis of prospectively collected data. Setting: Tertiary care teaching hospital. Patients: A total of 141 consecutive patients considered for Nissen fundoplication who also had Suspected DGE based on symptoms. Interventions: Of 141 patients, 63 had a time to 50% emptying (T1/2) greater than 90 minutes; 47 of the 63 of these had severe DGE (T1/2 > 150 minutes) and had Nissen fundoplication and pyloroplasty. Sixteen of the 141. with T1/2 greater than 90 but less than 150 minutes and 78 with normal gastric emptying findings (n = 78) had Nissen fundoplication only. Main Outcome Measures: Postoperatively, patients with symptom scores greater than 2 and/or abnormal 24-hour pH values (DeMeester score >14.7) were considered to have had unsuccessful treatment. Gastroesophageal reflux disease outcomes were compared between groups 1 and 2. Finally, the outcomes of both groups were compared with a control cohort of 418 patients with Nissen fundoplication and no DGE symptoms (group 3). Results: At the mean follow-tip of 21 months, there were no differences between the 2 groups regarding relief of reflux symptoms (DGE group, 54 of 63 [85.7%] vs NGE group, 71 of 78 [91.%]; P=.47) or objective control of acid reflux (DGE group, 33 of 39 [84.6%] vs NGE group, 41 of 51 [80.3%] P=.78). Dyspeptic symptoms were improved in the DGE group (P<.001); however, the overall incidence remained higher than the NGE group (P=.01). Postoperatively, T1/2 normalized in 88.23% (15 of 17) of patients. Postoperative objective outcomes were also no different between these groups and patients with Nissen fundoplication who did not have DGE symptoms (n = 418). Conclusions: Delayed gastric emptying does not affect outcomes of gastroesophageal reflux disease following Nissen fundoplication, but patients with DGE have more postoperative gas and bloat and/or nausea compared with patients with normal gastric emptying; this is mostly corrected by addition of a pyloroplasty.