Original Contribution | Published:


Effect of Vagus Nerve Integrity on Short and Long-Term Efficacy of Antireflux Surgery

The American Journal of Gastroenterology volume 111, pages 508515 (2016) | Download Citation



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.


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)).


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.


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.

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Author information


  1. Division of Gastroenterology–Hepatology, NUTRIM Research Institute, Maastricht University Medical Center, Maastricht, The Netherlands

    • S van Rijn
    • , N F Rinsma
    • , J M Conchillo
    •  & Adrian A M Masclee
  2. Department of General Surgery, Maastricht University Medical Center, Maastricht, The Netherlands

    • S van Rijn
    •  & N D Bouvy
  3. Department of Paediatric Surgery, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht, The Netherlands

    • M Y A van Herwaarden-Lindeboom
  4. Department of General Surgery, Leiden University Medical Center, Leiden, The Netherlands

    • J Ringers
  5. Department of OR/Evidence Based Surgery, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands

    • H G Gooszen
  6. Department of General Surgery, Lange Land Hospital Zoetermeer, Zoetermeer, The Netherlands

    • P J J van Rijn
  7. Department of Gastroenterology and Hepatology, Leiden University Medical Center, Leiden, The Netherlands

    • R A Veenendaal


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Competing interests

Guarantor of the article: Adrian A.M. Masclee, MD, PhD.

Specific author contributions: S. van Rijn: acquisition, analysis and interpretation of data, and drafting of manuscript. N.F. Rinsma: analysis of data and drafting of manuscript. M.Y.A. van Herwaarden-Lindeboom, J. Ringers, P.J.J. van Rijn, H.G. Gooszen, and R.A. Veenendaal: data acquisition. J.M. Conchillo: Approval of final manuscript. N.D. Bouvy: interpretation of data. A.A.M. Masclee: study concept, interpretation of data, drafting and approval of final manuscript, and overall study supervision.

Financial support: This study was conducted without funding.

Potential competing interests: None.

Corresponding author

Correspondence to Adrian A M Masclee.

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