Effect of Vagus nerve integrity on short and long-term efficacy of antireflux surgery

S. Van Rijn, N. F. Rinsma, M. Y A Van Herwaarden-Lindeboom, J. Ringers, H. G. Gooszen, P. J J Van Rijn, R. A. Veenendaal, J. M. Conchillo, N. D. Bouvy, Adrian A M Masclee*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


OBJECTIVES:Vagus nerve injury is a feared complication of antireflux surgery (ARS) that may negatively affect reflux control. The aim of the present prospective study was to evaluate short-term and long-term impact of vagus nerve injury, evaluated by pancreatic polypeptide response to insulin-induced hypoglycemia (PP-IH), on the outcome of ARS.METHODS:In the period from 1990 until 2000, 125 patients with gastroesophageal reflux disease (GERD) underwent ARS at a single center. Before and 6 months after surgery, vagus nerve integrity testing (PP-IH), 24-h pH-monitoring, gastric emptying, and reflux-associated symptoms were evaluated. In 2014, 14-25 years after surgery, 110 patients were contacted again for evaluation of long-term symptomatic outcome using two validated questionnaires (Gastrointestinal Symptom Rating Scale (GSRS) and GERD-Health Related Quality of Life (HRQL)).RESULTS:Short-term follow-up: vagus nerve injury (PP peak ≤47 pmol/l) was observed in 23 patients (18%) 6 months after fundoplication. In both groups, a comparable decrease in reflux parameters and symptoms was observed at 6-month follow-up. Postoperative gastric emptying was significantly delayed in the vagus nerve injury group compared with the vagus nerve intact group. Long-term follow-up: patients with vagus nerve injury showed significantly less effective reflux control and a higher re-operation rate.CONCLUSIONS:Vagus nerve injury occurs in up to 20% of patients after ARS. Reflux control 6 months after surgery was not affected by vagus nerve injury. However, long-term follow-up showed a negative effect on reflux symptom control and re-operation rate in patients with vagus nerve injury.

Original languageEnglish
Pages (from-to)508-515
Number of pages8
JournalAmerican Journal of Gastroenterology
Issue number4
Publication statusPublished - 1 Apr 2016


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