Ashwin A Kurian, MD, Carolyn Dougherty. Denver Esophageal and Stomach Center
|Symptom||Pre-op Score||Post-op Score||p value|
Introduction: Gastroparesis is a chronic illness presenting with nausea, vomiting, abdominal pain, bloating and malnutrition. Disease exacerbations result in repeated hospital admissions. Gastrectomy with Roux-en-Y reconstruction has been proposed as a palliative option for these patients.
Methods: Retrospective chart review was performed for gastroparesis patients who underwent laparoscopic near-total gastrectomy between January 2014 to August 2017. Patient demographics, pre- and post-operative symptom scores and outcomes were collected. Results were analyzed using statistical tests as appropriate.
Results: Twenty-nine patients underwent laparoscopic near-total gastrectomy for refractory gastroparesis. Twenty-two patients (76%) were idiopathic, seven patients (24%) were diabetic and six patients (21%) iatrogenic. Seven patients (24%) were male and twenty-two patients (76%) were female. Mean age was 44.8±9.05 and mean BMI was 27±7.
All patients had failed maximum medical management. Nine patients (31%) were dependent on enteral nutrition pre-operatively. Fourteen patients (48%) had prior intervention for gastroparesis. These interventions included pyloroplasty, gastric stimulator insertion, enteral feeding access, partial gastrectomy and Roux-en-Y gastric bypass.
Median hospital stay was 6±3 days. Nine patients (31%) required readmission within thirty days of their operation, primarily for recurrent symptoms resulting in dehydration. Four patients (14%) had immediate post-operative complications including one duodenal stump leak, two abdominal bleeds (managed laparoscopically) and one case of enteral nutrition related enteritis.
Mean duration of follow-up was nine months (1 month-30 months). Overall mean composite score [Gastropareis Cardinal Symptom Index: GCSI-2W] significantly decreased from 3.8±0.7 to 2.6±1.03 (p value 0.0001). Nausea, vomiting, bloating, and abdominal pain all significantly decreased. Ten patients (34%) remained on long-term enteral nutrition. Sixty-five percent of patients demonstrated a successful outcome as defined by a post-operative GCSI-2W symptom score < 3.2.
Conclusion: Laparoscopic near-total gastrectomy with Roux-en-Y reconstruction is a safe and efficacious palliative option for refractory gastroparesis. Despite the potential for a prolonged recovery, and the possible need for long-term enteral nutrition, most patients reported significant improvement in nausea, vomiting, abdominal pain, and bloating.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 87130
Program Number: S047
Presentation Session: Foregut Session
Presentation Type: Podium