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Surgical Endoscopy

, 25:3198 | Cite as

Postprandial proximal gastric acid pocket in patients after laparoscopic Nissen fundoplication

  • Fernando A. M. Herbella
  • Fernando P. P. Vicentine
  • Jose C. Del Grande
  • Marco G. Patti
Article

Abstract

Background

An unbuffered postprandial proximal gastric acid pocket (PPGAP) has been noticed in normal individuals and patients with gastroesophageal reflux disease (GERD). The role of gastric anatomy in the physiology of the PPGAP remains unclear. It is also unclear whether change in the PPGAP may contribute to GERD control. This study aims to analyze the presence of PPGAP in patients submitted to Nissen fundoplication.

Methods

Fifteen patients who had a laparoscopic Nissen fundoplication (mean age = 61 years, 13 females, mean time from operation 1 year) were studied. All patients were free of foregut symptoms. Patients underwent high-resolution manometry to identify the location of the lower border of the lower esophageal sphincter (LBLES).Station pull-through pH monitoring was performed from 5 cm below the LBLES to the LBLES in increments of 1 cm in a fasting state and 10 min after a standardized fatty meal.

Results

Four patterns of gastric acidity were found: (1) acid was not detected in the studied area of the stomach in 8 (53%) patients; (2) constant acidity (stomach is not alkalinized after meal), i.e., a buffered layer was not found in 3 (20%) patients; (3) PPGAP was not detected, i.e., the whole stomach is alkalinized, in 1 (7%) patient; and (4) PPGAP was noted in 3 (20%) patients with extensions of 2, 2, and 5 cm.

Conclusion

PPGAP is present in a minority of patients after Nissen fundoplication. This finding may explain part of the GERD control and that the gastric fundus may play a role in the genesis of the PPGAP.

Keywords

Gastroesophageal reflux Acid pocket Nissen fundoplication 

Notes

Acknowledgment

We are indebted to Ms. Mirian Wolfarth for her invaluable technical assistance with the esophageal tests. This study was supported by the Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) grant No. 2007/07940-8.

Disclosures

F. A. M. Herbella, F. P. P. Vicentine, J. C. Del Grande, and M. G. Patti have no conflicts of interest or financial ties to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Fernando A. M. Herbella
    • 1
    • 3
  • Fernando P. P. Vicentine
    • 1
  • Jose C. Del Grande
    • 1
  • Marco G. Patti
    • 2
  1. 1.Department of Surgery, Escola Paulista de MedicinaFederal University of São PauloSão PauloBrazil
  2. 2.Department of SurgeryUniversity of ChicagoChicagoUSA
  3. 3.Division of Esophagus and StomachHospital Sao Paulo, Surgical GastroenterologySao PauloBrazil

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