Laparoscopic Subtotal Y Roux Gastrectomy for Management of Refractary Gastroparesis. Experience IV Level Clinic in Colombia.


INTRODUCTION: Gastroparesis is a rare disease characterized by slow gastric emptying. Patients suffering from vomiting , abdominal postprandial fullnes . The most common cause is diabetes but 30 % can be idiopathic.

MAIN: To show our experience in the surgical management of patients with gastroparesis refractory to medical management.

METHODS: Descriptive . 3 patients operated in the first five months of 2015 , all male, 24, 26 and 65 y / o . All patients consulted for history of > 1 year of evolution weight loss about 20 kg , postprandial vomiting , fullness. none had vitamin deficiency or  diabetes.  I ordered endoscopy without mass, gastric emptying scintigraphy with solid delay which confirmed the diagnosis . Treatment was initiated with prokinetic , antiemetic, macrolids and diet indications for 1 month without improvement in symptoms, and loss more weight. They were scheduled for Laparoscopic subtotal Y Roux gastrectomy

RESULTS: Intraoperative  findings :dilated antrum and stomach thicker walls. Patients were hospitalized three day , the next day after surgery liquid diet was initiated , and was discharged with liquefied and month I advanced to soft diet .patients  did not show any postoperative complication . At 3 months postoperatively patients had scolded between 6-14 kg with very good tolerance to the diet. No dumping syndrome at moment.

CONCLUSION: The management of gastroparesis is controversial , medical management in moderate to severe cases is insufficient and stimulation therapy , jejunostomy or piloroplastia have not proved effective. Subtotal or total gastrectomy has shown good results in the long term regain weight and symptom relief.

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