Skip to main content
NCBI home page
Annals of Surgery logoLink to Annals of Surgery
. 1985 Mar;201(3):296–299. doi: 10.1097/00000658-198503000-00006

Fundoplication enhances gastric emptying.

G J Maddern, G G Jamieson
PMCID: PMC1250667  PMID: 3977428

Abstract

Fundoplication of the stomach is an established surgical treatment of gastroesophageal reflux. Its mechanism of action remains unclear. To assess its effect on gastric emptying, 21 patients (11 men, 10 women), median age 47 years (range 19-72), underwent a gastric emptying study before and 6 months after fundoplication. Gastric emptying studies were performed after an overnight fast using a dual isotope technic. Solid and liquid emptying rates were assessed over 120 minutes. The time taken for 50% of the liquid marker to leave the gastric region was a median of 22 minutes before surgery (range 9-35) and 13 minutes after surgery (range 9-27) (p less than 0.01). The percentage of solid remaining in the stomach 100 minutes after ingestion was 50% before surgery (range 19-90) and 44% after surgery (range 5-89) (p less than 0.01). We conclude that gastric emptying of both solids and liquids tends to be increased following fundoplication. This observation suggests a further mechanism for the efficacy of this operation in the treatment of gastroesophageal reflux.

Full text

PDF
296

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. BURFORD T. H., LISCHER C. E. Treatment of short esophageal hernia with esophagitis by Finney pyloroplasty. Ann Surg. 1956 Oct;144(4):647–652. doi: 10.1097/00000658-195610000-00008. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Behar J., Ramsby G. Gastric emptying and antral motility in reflux esophagitis. Effect of oral metoclopramide. Gastroenterology. 1978 Feb;74(2 Pt 1):253–256. [PubMed] [Google Scholar]
  3. Bjerkeset T., Nordgård K., Schjønsby H. Effect of Nissen fundoplication operation on the competence of the lower esophageal sphincter. Scand J Gastroenterol. 1980;15(2):213–217. doi: 10.3109/00365528009181457. [DOI] [PubMed] [Google Scholar]
  4. Bushkin F. L., Neustein C. L., Parker T. H., Woodward E. R. Nissen fundoplication for reflux peptic esophagitis. Ann Surg. 1977 Jun;185(6):672–677. doi: 10.1097/00000658-197706000-00009. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Collins P. J., Horowitz M., Cook D. J., Harding P. E., Shearman D. J. Gastric emptying in normal subjects--a reproducible technique using a single scintillation camera and computer system. Gut. 1983 Dec;24(12):1117–1125. doi: 10.1136/gut.24.12.1117. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Demeester T. R., Johnson L. F., Kent A. H. Evaluation of current operations for the prevention of gastroesophageal reflux. Ann Surg. 1974 Oct;180(4):511–525. doi: 10.1097/00000658-197410000-00016. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Ellis F. H., Jr, El-Kard M. F., Gibb S. P. The effect of fundoplication on the lower esophageal sphincter. Surg Gynecol Obstet. 1976 Jul;143(1):1–5. [PubMed] [Google Scholar]
  8. Ellis F. H., Jr, Garabedian M., Gibb S. P. Fundoplication for gastroesophageal reflux. Indications, surgical technique, and manometric results. Arch Surg. 1973 Aug;107(2):186–192. doi: 10.1001/archsurg.1973.01350200060015. [DOI] [PubMed] [Google Scholar]
  9. Fisher R. S., Malmud L. S., Lobis I. F., Maier W. P. Antireflux surgery for symptomatic gastroesophageal reflux: mechanism of action. Am J Dig Dis. 1978 Feb;23(2):152–160. doi: 10.1007/BF01073192. [DOI] [PubMed] [Google Scholar]
  10. Goodall R. J., Temple J. G. Effect of Nissen fundoplication on competence of the gastro-oesophageal junction. Gut. 1980 Jul;21(7):607–613. doi: 10.1136/gut.21.7.607. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. HERRINGTON J. L., Jr Hiatal hernia with esophagitis: treatment by hernia repair, vagotomy and pyloroplasty or antrectomy. Ann Surg. 1960 Jun;151:812–826. doi: 10.1097/00000658-196006000-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Hinder R. A. Individual and combined roles of the pylorus and the antrum in the canine gastric emptying of a liquid and a digestible solid. Gastroenterology. 1983 Feb;84(2):281–286. [PubMed] [Google Scholar]
  13. Hinder R. A., Kelly K. A. Canine gastric emptying of solids and liquids. Am J Physiol. 1977 Oct;233(4):E335–E340. doi: 10.1152/ajpendo.1977.233.4.E335. [DOI] [PubMed] [Google Scholar]
  14. Holt S., Reid J., Taylor T. V., Tothill P., Heading R. C. Gastric emptying of solids in man. Gut. 1982 Apr;23(4):292–296. doi: 10.1136/gut.23.4.292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Jamieson G. G., Duranceau A. C. The defense mechanisms of the esophagus. Surg Clin North Am. 1983 Aug;63(4):787–799. doi: 10.1016/s0039-6109(16)43080-x. [DOI] [PubMed] [Google Scholar]
  16. Kiroff G. K., Maddern G. J., Jamieson G. G. A study of factors responsible for the efficacy of fundoplication in the treatment of gastro-oesophageal reflux. Aust N Z J Surg. 1984 Apr;54(2):109–112. doi: 10.1111/j.1445-2197.1984.tb06699.x. [DOI] [PubMed] [Google Scholar]
  17. Little A. G., DeMeester T. R., Kirchner P. T., O'Sullivan G. C., Skinner D. B. Pathogenesis of esophagitis in patients with gastroesophageal reflux. Surgery. 1980 Jul;88(1):101–107. [PubMed] [Google Scholar]
  18. Maddern G. J., Horowitz M., Jamieson G. G., Chatterton B. E., Collins P. J., Roberts-Thomson P. Abnormalities of esophageal and gastric emptying in progressive systemic sclerosis. Gastroenterology. 1984 Oct;87(4):922–926. [PubMed] [Google Scholar]
  19. McCallum R. W., Berkowitz D. M., Lerner E. Gastric emptying in patients with gastroesophageal reflux. Gastroenterology. 1981 Feb;80(2):285–291. [PubMed] [Google Scholar]
  20. Meyer J. H., MacGregor I. L., Gueller R., Martin P., Cavalieri R. 99mTc-tagged chicken liver as a marker of solid food in the human stomach. Am J Dig Dis. 1976 Apr;21(4):296–304. doi: 10.1007/BF01071842. [DOI] [PubMed] [Google Scholar]
  21. NISSEN R. Eine einfache Operation zur Beeinflussung der Refluxoesophagitis. Schweiz Med Wochenschr. 1956 May 18;86(Suppl 20):590–592. [PubMed] [Google Scholar]
  22. Papp J. P. Determination of the lower esophageal sphincter pressure in patients having a Nissen or Belsey fundoplication. Am J Gastroenterol. 1979 Feb;71(2):154–157. [PubMed] [Google Scholar]
  23. Rees W. D., Go V. L., Malagelada J. R. Antroduodenal motor response to solid-liquid and homogenized meals. Gastroenterology. 1979 Jun;76(6):1438–1442. [PubMed] [Google Scholar]
  24. Stanghellini V., Malagelada J. R., Zinsmeister A. R., Go V. L., Kao P. C. Stress-induced gastroduodenal motor disturbances in humans: possible humoral mechanisms. Gastroenterology. 1983 Jul;85(1):83–91. [PubMed] [Google Scholar]
  25. Vansant J. H., Baker J. W., Jr Complications of vagotomy in the treatment of hiatal hernia. Ann Surg. 1976 Jun;183(6):629–635. doi: 10.1097/00000658-197606000-00003. [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Velasco N., Hill L. D., Gannan R. M., Pope C. E., 2nd Gastric emptying and gastroesophageal reflux. Effects of surgery and correlation with esophageal motor function. Am J Surg. 1982 Jul;144(1):58–62. doi: 10.1016/0002-9610(82)90602-x. [DOI] [PubMed] [Google Scholar]

Articles from Annals of Surgery are provided here courtesy of Lippincott, Williams, and Wilkins

RESOURCES