Katelin A Mirkin, MD, Ann M Rogers, MD. Penn State Health Milton S. Hershey Medical Center
Introduction: In patients with severe obesity and gastroparesis, sleeve gastrectomy can improve symptoms and may be a reasonable treatment option. We report a case series of four patients with gastroparesis documented by preoperative nuclear gastric emptying study, who experienced improvement in symptoms after laparoscopic sleeve gastrectomy.
Methods and Procedures: A prospectively maintained database of all patients who underwent sleeve gastrectomy at our institution from 2008-2017 was reviewed, searching for patients with preoperative clinical diagnosis of gastroparesis and gastric emptying studies. Outcomes assessed were clinical resolution of symptoms with follow-up of 1 year.
Results: Four patients met inclusion criteria, all females, ages 34 to 58, with BMIs ranging from 41-44. Preoperatively, the patients had symptoms of nausea and vomiting that failed to improve with medical management. Two of the patients had insulin-dependent diabetes. All four patients underwent laparoscopic sleeve gastrectomy; one also underwent anterior cruraplasty for a small hiatal hernia, without complications. Two of the patients were discharged on post-operative day one and the others on post-operative day two, all tolerating a liquid diet. At 1 year follow up, BMI had decreased by an average of 5.9 points. At 1 year follow-up, all four patients reported complete resolution of symptoms.
Conclusions: To date there are only 13 reported cases in the literature of improvement of gastroparesis after sleeve gastrectomy. In bypass patients, gastroparesis was previously treated with an adjuvant gastrostomy tube in the remnant stomach to prevent nausea or distention. This is likely unnecessary. Sleeve gastrectomy led to resolution of gastroparesis in all patients in our database, and may be the bariatric procedure of choice for patients with this diagnosis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 94021
Program Number: P094
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster