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Vagus nerve injury linked to reduced long-term efficacy of antireflux surgery
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For patients who underwent antireflux surgery, those who had vagus nerve injury also had significantly less effective reflux control and higher re-operation rates in the long-term, according to the results of a recent study.
“Vagus nerve injury is a well-known complication of [antireflux surgery],” occurring in up to 20% of patients who undergo the procedure,” the researchers wrote. “[The] aim of our study was to evaluate both short- and long-term impact of vagus nerve injury as evaluated by the [insulin hypoglycemia-pancreatic polypeptide] test on reflux symptoms, reflux control and quality of life after ARS.”
The researchers prospectively evaluated 125 patients with GERD who underwent ARS at the Leiden University Medical Centre in the Netherlands between 1990 and 2000. They collected data on gastric emptying, vagus nerve integrity testing, 24-hour pH-monitoring, and esophageal manometry before and 6 months after surgery. Questionnaires evaluating symptoms were also completed during data collection. At 14 to 25 years after surgery, the researchers contacted 110 of the patients who completed validated questionnaires for long-term follow-up.
At 6 months, 18% of the patients exhibited vagus nerve injury (polypeptide peak ≤ 47 pmol/L). Researchers observed comparable reductions in reflux parameters and symptoms in patients with and without vagus nerve injury at 6 months. In those with vagus nerve injury, postoperative gastric emptying was significantly delayed compared with the vagus nerve intact group (P < .001).
Long-term follow-up showed significantly less effective reflux control and a higher reoperation rate in the group with vagus nerve injury. GERD Health-related Quality of Life questionnaire scores (P < .001) and patient satisfaction rates (P < .05) were significantly lower. Reoperation occurred in 54% of those with vagus nerve injury vs. 16% of those without vagus nerve injury (P = .007).
“Vagus nerve injury does not negatively affect short-term reflux control 6 months after antireflux surgery,” the researchers concluded. “However, long-term follow-up showed a negative effect on symptom control and a significantly higher re-operation rate in patients with vagus nerve injury. Preserving the main trunks of the vagus nerve is therefore of utmost importance in order to maintain vagus nerve integrity and contribute to reflux control after ARS.” – by Suzanne Reist
Disclosures: The researchers report no relevant financial disclosures.
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