Gastric emptying and vagus nerve function after laparoscopic partial fundoplication

Area of Science:

• Gastroenterology
• Surgical Innovation
• Neurogastroenterology

Background:

• Delayed gastric emptying affects up to 40% of gastroesophageal reflux disease (GERD) patients.
• Antireflux surgery typically normalizes or accelerates gastric emptying.
• Vagus nerve injury is suspected as a cause of severe gastric stasis post-surgery.

Purpose of the Study:

• To investigate the relationship between vagus nerve function, gastric emptying, and outcomes after antireflux surgery.
• To assess the impact of laparoscopic hemifundoplication on gastric motility and vagal integrity.

Main Methods:

• Prospective evaluation of 41 patients undergoing laparoscopic hemifundoplication.
• Assessment of solid meal gastric emptying and vagus nerve function (via pancreatic polypeptide response to hypoglycemia) pre- and post-surgery.

Main Results:

• Significant improvement in gastric emptying post-surgery (reduced lag phase, increased emptying rate, shorter half-emptying time).
• Gastric emptying improved similarly in patients with pre-existing delayed or normal emptying.
• Vagus nerve damage signs (low pancreatic polypeptide peak) observed in 10% of patients, but without impact on gastric emptying.

Conclusions:

• Laparoscopic hemifundoplication enhances gastric emptying, even in patients with initial delays.
• While 10% of patients show signs of vagus nerve compromise, this does not result in delayed gastric emptying.
• The procedure is effective in improving gastric motility and reflux symptoms without causing significant gastric stasis.