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Function of the proximal stomach after partial versus complete laparoscopic fundoplication
M Y A Lindeboom1, M K Vu, J Ringers
1Department of Gastroenterology-Hepatology, Leiden University Medical Center, The Netherlands.
The American Journal of Gastroenterology
|February 20, 2003
Summary
Antireflux surgery impairs gastric fundus relaxation, causing fullness after both partial and complete fundoplication. This effect is linked to the time since surgery, not the surgical type.
Area of Science:
- Gastroenterology
- Surgical Outcomes
- Digestive Physiology
Background:
- Dyspeptic symptoms like fullness occur in over 30% of patients post-antireflux surgery.
- These symptoms are linked to fundoplication-induced changes in proximal gastric motor and sensory function, particularly impaired postprandial relaxation.
- Previous research suggests impaired fundus relaxation may differ between complete and partial fundoplications.
Purpose of the Study:
- To investigate and compare proximal gastric motor and sensory function after partial versus complete fundoplication.
- To determine if impaired fundus relaxation is more pronounced after complete fundoplication.
- To explore the relationship between fundoplication type, gastric function, and dyspeptic symptoms.
Main Methods:
- Proximal gastric motor and sensory function were assessed using an electronic barostat in patients post-laparoscopic partial fundoplication (n=14), complete fundoplication (n=14), GERD patients (n=12), and healthy controls (n=15).
- Fasting and postprandial gastric function were measured.
- Gastric emptying and vagus nerve function tests were conducted in all surgical patients.
Main Results:
- Maximal postprandial fundus relaxation was significantly reduced in both partial (267 ± 32 ml) and complete (294 ± 34 ml) fundoplication groups compared to GERD patients (448 ± 30 ml) and controls (409 ± 25 ml).
- No significant difference in fullness sensation was observed between partial and complete fundoplication groups.
- A significant positive correlation was found between postoperative duration and the degree of postprandial fundus relaxation (r=0.67, p<0.001).
Conclusions:
- Both partial and complete fundoplication impact proximal gastric motor function, leading to impaired postprandial relaxation and increased fullness.
- The observed alterations in gastric function are not dependent on the type of fundoplication performed.
- The degree of gastric relaxation impairment correlates significantly with the duration of the postoperative period.