ObjectiveTo study the effect of Nissen fundoplication on the pattern of gastric emptying and intragastric distribution of symptoms in patients with normal and delayed gastric emptying before surgery, especially in those with delayed emptying before surgery. Summary Background DataGastroesophageal reflux disease is associated with delayed gastric emptying and dyspeptic symptoms in approximately 40% of the patients. After Nissen fundoplication, dyspeptic symptoms are also not uncommon. MethodsThirty-six patients (26 men, 10 women, mean age 43.1) were studied before and 3 months after Nissen fundoplication. Gastric emptying (dual-isotope, expressed in lag phase, emptying rate, T 50 , and intragastric distribution) was not included in the decision for surgery. Reflux-related and dyspeptic symptoms were scored before and at 3, 6, and 12 months after surgery. ResultsTwenty-six patients had normal and 10 had delayed gastric emptying before surgery. Nissen fundoplication on average enhanced gastric emptying for solids in both subgroups by a combination of a decrease in mean lag phase, emptying rate, and T 50 . The preoperative difference in intragastric distribution between patients with and without delayed gastric emptying was abolished by fundoplication. Patients with normal gastric emptying before surgery showed an increase in early postprandial satiety; in those with delayed emptying, this was not observed. A correlation was found between preoperative T 50 for liquid gastric emptying and postoperative nausea at 3 months in patients with normal gastric emptying. In patients with delayed emptying, preoperative correlations between lag phase for liquids and nausea respectively early satiety were significant, as well as for T 50 for liquids and vomiting. ConclusionsNissen fundoplication equalizes the preoperative difference in intragastric distribution and accelerates gastric emptying without an effect on symptoms in patients with preexisting delayed gastric emptying, but with an increase in early satiety in patients with normal gastric emptying. Delayed gastric emptying is not a contraindication for antireflux surgery.Gastroesophageal reflux disease (GERD) is associated with delayed gastric emptying for solids and liquids in approximately 40% of the patients. [1][2][3][4][5] Whereas several studies showed that enhancement of delayed gastric emptying by prokinetic drugs improves symptoms of gastroesophageal reflux, 6 -9 others found no correlation between reflux and delayed emptying.3,10 -12 Delayed gastric emptying probably plays a causative role in GERD, and delayed gastric emptying has even been considered a contraindication for antireflux surgery. It has been shown that antireflux surgery accelerates gastric emptying, but this does not imply that gastric function has been improved and will have a positive effect on upper gastrointestinal symptoms. 13,14 In the studies presented, patients have not been subdivided in those with and those without delayed emptying before surgery, and such a subdivision has not been rela...

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We describe a case of extensive soft palate ulceration after the use of an i-gel supraglottic airway device (Intersurgical Ltd, Wokingham, United Kingdom) during a knee arthroscopy in a 61-year-old man. He presented with pain and soft palate ulceration, which eventually required hospital admission because of dehydration. The pharynx healed completely within 3 months, with a change in taste as the remaining symptom.

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