OBJECTIVE: To assess whether careful dissection and isolation of vagus nerves from the three-quarter Nissen fundoplication wrap (a periesophageal posterior gastric wrap 270 degrees in circumference) could modify the postoperative outcome and reduce postoperative gastric emptying disturbances. DESIGN: Open randomized control trial. SETTING:University hospital. PATIENTS: Forty-two patients with proved esophageal reflux and indication for surgery, after informed consent. INTERVENTIONS: A three-quarter Nissen fundoplication with (21 cases) or without (21 cases) dissection and exclusion of vagus nerves from the wrap. MAIN OUTCOME MEASURES: Standard questionnaire, acid reflux test, and gastric emptying study before and 3 months after surgery. RESULTS: No difference was found between the groups. There was a correlation between preoperative and post-operative gastric emptying. CONCLUSION: Exclusion of the vagus nerves from the three-quarter Nissen fundoplication wrap provides no advantage on postoperative gastric emptying and does not affect outcome of reflux surgery.
RCT Entities:
OBJECTIVE: To assess whether careful dissection and isolation of vagus nerves from the three-quarter Nissen fundoplication wrap (a periesophageal posterior gastric wrap 270 degrees in circumference) could modify the postoperative outcome and reduce postoperative gastric emptying disturbances. DESIGN: Open randomized control trial. SETTING: University hospital. PATIENTS: Forty-two patients with proved esophageal reflux and indication for surgery, after informed consent. INTERVENTIONS: A three-quarter Nissen fundoplication with (21 cases) or without (21 cases) dissection and exclusion of vagus nerves from the wrap. MAIN OUTCOME MEASURES: Standard questionnaire, acid reflux test, and gastric emptying study before and 3 months after surgery. RESULTS: No difference was found between the groups. There was a correlation between preoperative and post-operative gastric emptying. CONCLUSION: Exclusion of the vagus nerves from the three-quarter Nissen fundoplication wrap provides no advantage on postoperative gastric emptying and does not affect outcome of reflux surgery.
Authors: M A Khoursheed; M Al-Asfoor; M Al-Shamali; A K Ayed; R Gupta; H M Dashti; A I Behbehani Journal: Ann R Coll Surg Engl Date: 2001-07 Impact factor: 1.891