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Am J Gastroenterol. 2016 Apr;111(4):508-15. doi: 10.1038/ajg.2016.42. Epub 2016 Mar 15.

Effect of Vagus Nerve Integrity on Short and Long-Term Efficacy of Antireflux Surgery.

Author information

1
Division of Gastroenterology-Hepatology, NUTRIM Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands.
2
Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
3
Department of Paediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands.
4
Department of General Surgery, Leiden University Medical Center, Leiden, The Netherlands.
5
Department of OR/Evidence Based Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
6
Department of General Surgery, Lange Land Hospital Zoetermeer, Zoetermeer, The Netherlands.
7
Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands.

Abstract

OBJECTIVES:

Vagus nerve injury is a feared complication of antireflux surgery (ARS) that may negatively affect reflux control. The aim of the present prospective study was to evaluate short-term and long-term impact of vagus nerve injury, evaluated by pancreatic polypeptide response to insulin-induced hypoglycemia (PP-IH), on the outcome of ARS.

METHODS:

In the period from 1990 until 2000, 125 patients with gastroesophageal reflux disease (GERD) underwent ARS at a single center. Before and 6 months after surgery, vagus nerve integrity testing (PP-IH), 24-h pH-monitoring, gastric emptying, and reflux-associated symptoms were evaluated. In 2014, 14-25 years after surgery, 110 patients were contacted again for evaluation of long-term symptomatic outcome using two validated questionnaires (Gastrointestinal Symptom Rating Scale (GSRS) and GERD-Health Related Quality of Life (HRQL)).

RESULTS:

Short-term follow-up: vagus nerve injury (PP peak ≤47 pmol/l) was observed in 23 patients (18%) 6 months after fundoplication. In both groups, a comparable decrease in reflux parameters and symptoms was observed at 6-month follow-up. Postoperative gastric emptying was significantly delayed in the vagus nerve injury group compared with the vagus nerve intact group. Long-term follow-up: patients with vagus nerve injury showed significantly less effective reflux control and a higher re-operation rate.

CONCLUSIONS:

Vagus nerve injury occurs in up to 20% of patients after ARS. Reflux control 6 months after surgery was not affected by vagus nerve injury. However, long-term follow-up showed a negative effect on reflux symptom control and re-operation rate in patients with vagus nerve injury.

PMID:
26977759
DOI:
10.1038/ajg.2016.42
[Indexed for MEDLINE]

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