Sherard Chiu, MD, Gregory J Mancini, MD, Sarah Campbell, PA, Matthew L Mancini, MD. University of Tennessee Graduate School of Medicine Knoxville
INTRODUCTION: Pyloroplasty for refractory gastroparesis has traditionally been performed laparoscopically. We believe pyloroplasty performed robotically using the Heineke-Mikulicz technique is a viable treatment method for refractory gastroparesis. Many patients who have failed medical management will seek surgical options including gastric stimulator implantation, subtotal gastrectomy, or pyloroplasty. We present our own institution experience of robotic pyloroplasty (RP) as a treatment for refractory gastroparesis.
METHODS AND PROCEDURES: This is a case series looking at our patients who had undergone robotic pyloroplasty since December 2015. Charts were reviewed for indications, complications, and outcomes. Gastroparesis was defined by abnormal gastric emptying study, endoscopic visualization of retained food after prolonged NPO status, or suspicion of vagal nerve injury. Patients that had recalcitrant gastroparesis who had failed medical treatment and/or gastric pacemaker placement were treated with robotic pyloroplasty. The surgical technique was the same in all patients, using the DaVinci system to accomplish a hand sewn Heineke-Mikulicz pyloroplasty. Of our 7 patients, we have followed their levels of nausea, vomiting, bloating, reflux, and early satiety every 30 days since their operation. We also investigated operative time as we believe the robotic procedure may help to decrease time and cost.
RESULTS: More than half of our 7 patients reported improvement in their symptoms and were happy with their results. None of our patients had any major complications (leaks, bleeding) due to the robotic procedure. Our operative times ranged from 54 minutes to 108 minutes, averaging 85.43 ± 17.39 minutes with a median of 86 minutes.
CONCLUSIONS: Patients with recalcitrant gastroparesis can be very difficult to manage, especially those who fail medical therapy. These patients tend to seek surgical options like gastric pacemaker placement or pyloroplasty. Due to the nature of the pyloroplasty procedure, sewing with the enhanced dexterity offered by the robot makes sense. From our series, we believe robotic pyloroplasty is a viable method for treating recalcitrant gastroparesis.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 80546
Program Number: P680
Presentation Session: Poster (Non CME)
Presentation Type: Poster