The effect of fundoplication with or without proximal gastric vagotomy on gastric emptying and serum gastrin.

Jordan and Herrington have both advocated the addition of a proximal gastric vagotomy [PGV] to fundoplication to improve exposure and decrease the likelihood of vagal entrapment which might lead to delayed gastric emptying. This study documents the effect of fundoplication with or without PGV on gastric emptying and postprandial gastrin values. Twelve dogs had measurement of gastric emptying of an isotopically labeled solid meal. Plasma gastrin was also measured at 15-min intervals for 1 hr postprandially following a 60 g beef meal. Six of the animals then had a standard fundoplication with incorporation of vagi in the wrap; the other six underwent fundoplication combined with PGV, excluding the vagi. All studies were repeated after 8 weeks. Gastric emptying was unchanged by fundoplication alone. PGV resulted in a slight but significant slowing of gastric emptying (P = 0.04), values by paired t test. Fundoplication alone had no effect on serum gastrin levels, but there was a slight, statistically insignificant increase in serum gastrin when PGV was added (P greater than 0.1). This delay could aggravate pre-existing emptying problems in patients with esophagitis. These data do not support inclusion of proximal gastric vagotomy as a routine part of the fundoplication.