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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.

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



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.


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)).


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.


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.

[Indexed for MEDLINE]

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