Partial Longitudinal Gastrectomy: A Novel Curative Approach for Gastroparesis

Avishai Meyer, MD, Pradeep Pallati, MD, Abhijit Shaligram, MBBS, Dmitry Oleynikov, MD, Matthew Goede, MD. University of Nebraska Medical Center

 

 Background: Gastroparesis is a disorder that affects thousands of worldwide. It is marked by a stomach’s inability to properly empty its contents. The mainstay of treatment to date has been pharmaco-therapeutic in nature (e.g. prokinetic agents, diabetes management, etc). Surgical intervention is usually reserved for recalcitrant cases. The aim of this initial study was to determine whether partial longitudinal gastrectomy without anastomosis (sleeve gastrectomy) could significantly improve gastric emptying.

Study Design: Nine morbidly obese patients (8 female, 1 male) diagnosed with gastroparesis were prospectively followed after undergoing sleeve gastrectomy. All patients were preoperatively evaluated by radionuclide gastric emptying studies. Pre and postoperative BMIs and symptoms were assessed. Two surgeons performed all operations in a standardized fashion with EGD evaluation. Postoperatively, weight loss was calculated. There were no operative complications.

Results: All nine patients reported improved symptoms following longitudinal gastrectomy (mean followup 8 months). Average preoperative BMI was 39.2. Postoperatively, BMI decreased to 36.2 with an average weight loss of 12.3 kg. All patients reported resolution of their pre-operative abdominal pain and distension. The most common post-operative symptom noted was vomiting (3/9). One patient remains on prokinetics (metoclopramide). Four patients had postoperative radionuclide gastric emptying studies, of which three now show normal gastric emptying.

Conclusions: A novel technique of partial longitudinal gastrectomy without anastomosis has been proposed as a treatment for patients with gastroparesis.
Beyond the improvement in gastric emptying, hormonal changes from the removal of the gastric fundus may make diabetic control easier. Larger studies with a longer follow up are needed, in both morbidly obese and non-morbidly obese patients, to evaluate if this type of gastrectomy leads to a durable resolution of symptoms.


Session Number: Poster – Poster Presentations
Program Number: P249
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