We sought to evaluate vagus nerve integrity before and after antireflux surgery and to compare it with symptomatic outcome. Antireflux surgery patients were recruited. Patients with disorders associated with vagus dysfunction or who took medications with anticholinergic effects were excluded. Each patient underwent a sham-feeding-stimulated pancreatic polypeptide (PP) test before and after surgery. A symptom survey was also administered. Twenty patients completed preoperative testing; their mean age was 57 years, and postoperative testing results were available for 16 of them. Of the 20, 14 (70%) had an appropriate increase in PP level with sham-meal preoperatively. All 4 patients with an abnormal preoperative test remained abnormal, and 5 of 12 (42%) with a normal preoperative test had an abnormal postoperative result; thus 9 of 16 (56%) had an abnormal postoperative PP test. In 15 patients, assessments of bowel function were obtained before and after surgery. Six of 15 (40%) patients developed new or worse symptoms (diarrhea in 4, flatus in 2). The symptoms did not correlate with PP results. This suggests that some patients referred for antireflux surgery have evidence of abnormal vagus function that persists after surgery. Many patients (42%) with normal testing before surgery develop an abnormal test after surgery. There was no correlation between PP tests and the development or worsening of bowel symptoms.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Spechler SJ. Comparison of medical and surgical therapy for complicated gastroesophageal reflux disease in veterans. N Engl J Med 1992;326:786–792.
Lundell L, Miettinen P, Myrvold HE, et al. Continued (5-year) followup of a randomized clinical study comparing antireflux surgery and omeprazole in gastroesophageal reflux disease. J Am Coll Surg 2001;192:172–179.
Klaus A, Hinder RA, DeVault KR, Achem SR. Bowel dysfunction after laparoscopic antireflux surgery; incidence, severity and clinical course. Am J Med 2003;114:6–9.
Malhi-Chowla N, Gorecki P, et al. Dilation after fundoplication: timing, frequency, indications and success. Gastrointest Endosc 2002;55:219–223.
Peetsalu A, Peetasalu M. Interpretation of postvagotomy endoscopic Congo red test results in relation to ulcer recurrence 5 to 12 years after operation. Am J Surg 1998;175:472–476.
Debas HT. The vagus. Am Surg 1976;42:498–502.
Camilleri M. Study of human gastroduodenojejunal motility. Applied physiology in clinical practice. Dig Dis Sci 1993;38:785–794.
Anagnostides A, Chadwick VS, Selden AC, Maton PN. Sham feeding and pancreatic secretion. Evidence for direct vagal stimulation of enzyme output. Gastroenterology 1984;87:109–114.
Koch MB, Go VLW, DiMagno EP. Can plasma human pancreatic polypeptide be used to detect diseases of the exocrine pancreas? Mayo Clin Proc 1985;60:259–266.
Camilleri M, Balm RK, Low PA. Autonomic dysfunction in patients with chronic intestinal pseudo-obstruction. Clin Auton Res 1993;3:95–100.
Klingler PJ, Bammer T, Wetscher GJ, et al. Minimally invasive surgical techniques for the treatment of gastroesophageal re.ux disease. Dig Dis 1999;17:23–36.
DeVault KR, Castell DO. Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am J Gastroenterol 1999;94:1434–1442.
So JBY, Zeitels SM, Rattner DW. Outcomes of atypical symptoms attributed to gastroesophageal reflux treated by laparoscopic fundoplication. Surgery 1998;124:28–32.
Spechler SJ, Lee E, Ahnen D, et al. Long-term outcome of medical and surgical therapies for gastroesophageal reflux disease. Follow-up of a randomized controlled trial. JAMA 2001; 285:2331–2338.
Bammer T, Hinder RA, Klingler PJ, Rodriguez JA, Napoliello DA. Five to eight year outcome of the first laparoscopic Nissen fundopications. JGASTROINTEST SURG 2001;5:42–47.
Lord RV, Kaminski A, Oberg S, et al. Absence of gastroesophageal reflux disease in amajority of patients taking acid suppression medications afterNissen fundoplication. JGASTROINTEST SURG 2002;6:3–10.
Bais JE, Bartelsman JF, Bonjer BJ, et al. Laparoscopic or conventional Nissen fundoplication for gastro-oesophageal reflux disease: randomized clinical trial. Lancet 2000;355:170–174.
Pouderoux P, Ergun GA, Lin S, Kahrilas PJ. Esophageal bolus transit imaged by ultrafast computerized tomography. Gastroenterology 1996;110:1422–1428.
Pimentel M, Rossi F, Chow EJ, et al. Increased prevalence of irritable bowel syndrome in patients with gastroesophageal reflux. J Clin Gastroenterol 2002;34:221–224.
Axelrod DA, Divi V, Ajluni MM, Eckhauser FE, Colletti LM. Influence of functional bowel disease on outcome of surgical antireflux procedures. J Gastrointest Surg 2002;6:632–637.
Bu.er P, Ehringhaus C, Koletzko S. Dumping syndrome: a common problem following Nissen fundoplication in young children. Pediatr Surg Int 2001;17:351–355.
Hinder RA, Stein HJ, Bremner CG, DeMeester TR. Relationship of a satisfactory outcome to normalization of delayed gastric emptying after Nissen fundoplication. Ann Surg 1989; 210:458–465.
Valdovinos MA, Camilleri M, Zimmerman BR. Chronic diarrhea in diabetes mellitus: mechanisms and an approach to diagnosis and treatment. Mayo Clin Proc 1993;68:691–702.
Chelimsky G, Chelimsky TC. Evaluation and treatment of autonomic disorders of the gastrointestinal tract. SeminNeurol 2003;23:453–458.
Vu MK, Ringers J, Arndt JW, Lamers CB, Masclee AA. Prospective study of the effect of laparoscopic hemifundoplication on motor and sensory function of the proximal stomach. Br J Surg 2000;87:338–343.
Ren J, Shaker R, Kusano M, et al. Effect of aging on the secondary esophageal peristalsis: presbyesophagus revisited. Am J Physiol 1995;268:G772-G779.
Lasch H, Castell DO, Castell JA. Evidence for diminished visceral pain with aging: studies using graded intraesophageal balloon distension. Am J Physiol 1997;272:G1-G3.
Trus TL, Laycock WS, WoJM, et al. Laparoscopic antireflux surgery in the elderly. Am J Gastroenterol 1998;93:351–353.
Kamolz T, Bammer T, Granderath FA, Pasiut M, Pointner R. Quality of life and surgical outcome after laparoscopic antire-flux surgery in the elderly gastroesophageal reflux disease patient. Scand J Gastroenterol 2001;36:116–120.
About this article
Cite this article
DeVault, K.R., Swain, J.M., Wentling, G.K. et al. Evaluation of vagus nerve function before and after antireflux surgery. J Gastrointest Surg 8, 881–887 (2004). https://doi.org/10.1016/j.gassur.2004.07.002