The effect of floppy Nissen fundoplication on esophageal and gastric motility in gastroesophageal reflux.

Thirty-five patients with gastroesophageal reflux (GER) proved on ambulatory esophageal hydrogen monitoring were surgically treated by a floppy Nissen fundoplication. Postoperatively, reflux and symptoms related to it were almost completely abolished. Transient bloating syndrome was observed in five instances. The operation significantly improved esophagitis (p < 0.01), increased lower esophageal sphincter pressure (p < 0.01) and increased amplitude of esophageal peristalsis (p < 0.01). However, postoperative motility of the esophagus as detected by manometry was still impaired as compared with that for the control group. Delayed esophageal transit did not improve postoperatively, although no dysphagia was accounted. Impaired esophageal motility in GER was associated with delayed gastric emptying, which, however, improved postoperatively. It is concluded that esophageal and gastric motor abnormalities are rather primary disorders in GER. After successful fundoplication, esophageal dysmotility, aggravated by reflux esophagitis, improves to some extent, while gastric emptying is enhanced.