Laparoscopic Nissen fundoplication is the most frequently performed operation for gastro-esophageal reflux disease (GERD).
However, 12% of the patients have persistent reflux symptoms and 19% develop gas-related symptoms after laparoscopic Nissen fundoplication.
Weakly acidic reflux and inability to belch have been alleged to cause these symptoms, respectively.
|The procedure reduced the incidence of liquid and mixed reflux |
Dr Broeders and colleagues from the Netherlands evaluated the effect of laparoscopic Nissen fundoplication on weakly acidic reflux and (supra) gastric belching.
In 31 patients with upper gastrointestinal endoscopy, stationary esophageal manometry and 24-hours impedance–pH monitoring off acid secretion inhibiting drugs was performed before and 6 months after primary laparoscopic Nissen fundoplication for GERD that was refractory to proton pump inhibitors.
Patients filled out validated questionnaires on GERD-health-related quality of life before and 3, 6 and 12 months after surgery.
The research team found that laparoscopic Nissen fundoplication reduced reflux symptoms.
The researchers noted that the procedure drastically reduced the incidence of acid, and weakly acidic as well as liquid and mixed reflux episodes.
In contrast, the team noted that gas reflux was reduced to lesser extent.
Proximal, mid-esophageal and distal reflux were reduced to a similar extent.
Persistent GERD symptoms were neither preceded by acid nor by weakly acidic reflux.
The research team found that the number of air swallows did not change, but the number of gastric belches was greatly reduced.
The research team found that 23 patients had supragastric belches, both before and after surgery, whereas 8 patients had none at all.
The researchers found that the majority of supragastric belches were not reflux associated, and the frequency was greatly increased after laparoscopic Nissen fundoplication.
Reflux-associated supragastric belches were abolished after surgery.
Dr Broeders' team concluded, "Laparoscopic Nissen fundoplication similarly controls acid and weakly acidic reflux, but gas reflux is reduced to lesser extent."
"Persistent reflux symptoms are neither caused by acid nor by weakly acidic reflux."
"Laparoscopic Nissen fundoplication alters the belching pattern by reducing gastric belches and increasing supragastric belches."
"This explains the increase in belching experienced by some patients after laparoscopic Nissen fundoplication, despite the reduction in gastric belching."
"It can be hypothesized that the reduction in gastric belches after laparoscopic Nissen fundoplication incites patients to increase supragastric belches in a futile attempt to vent air from the stomach."