Roux-en-Y Gastric Bypass versus Gastrectomy with Roux-en-Y Reconstruction for the Treatment of Gastroparesis

Joshua P Landreneau, MD, MSc¹, Andrew T Strong, MD¹, Kevin El-Hayek, MD¹, Ricard Corcelles, MD², Matthew Kroh, MD², John Rodriguez, MD¹. ¹Cleveland Clinic, ²Cleveland Clinic Abu Dhabi

Introduction: Gastroparesis is a debilitating functional disorder of the stomach marked by delayed gastric emptying in the absence of mechanical obstruction. Patients with severe, refractory symptoms may ultimately be managed with Roux-en-Y gastric bypass (RYGB) or gastrectomy with Roux-en-Y reconstruction. However it is unclear whether the stomach may left in situ, as with a RYGB, or resected as in gastrectomy. The present study aims to compare perioperative outcomes and long-term symptomatic relief between these operations.

Methods: All patients underwent RYGB or gastrectomy for the treatment of gastroparesis (GP) at our institution from September 2010 through March 2018 were retrospectively reviewed. Patients with prior gastric resection or whose primary operative indication was not gastroparesis were excluded from analysis.

Results: Twenty-six patients underwent RYGB and twenty-seven patients underwent gastrectomy with Roux-en-Y reconstruction during the study period. The mean age was 49.7 years in the RYGB cohort and 48.5 years in the gastrectomy cohort. The mean duration of GP symptoms was 2.7 years for patients treated with RYGB and 3.6 years for those undergoing gastrectomy. Preoperative BMI was lower in the gastrectomy cohort (29.2 vs. 34.3 kg/m2, p=0.01). Etiology of gastroparesis was similar between the two cohorts. Patients undergoing gastrectomy were more likely to have previous interventions for GP (63.0% versus 26.9%). All RYGB cases were completed laparoscopically. While all gastrectomies were attempted laparoscopically, three (11.1%) converted to open. RYGB was associated with a shorter operative time (155 vs. 223 minutes), less blood loss (24 vs. 130 mL), and shorter length of stay (4.0 vs. 7.2 days). Twelve patients (44.4%) had complications within 30 days following gastrectomy compared to two patients (5.4%) following RYGB. Complications after gastrectomy included surgical-site infection (SSI) (14.8% superficial, 11.1% organ-space), unplanned ICU admission (18.5%), reoperation (18.5%), gastrointestinal hemorrhage (7.4%), and deep-vein thrombosis (3.7%). A single patient in the RYGB cohort (3.8%) experienced a superficial SSI. Patients in the RYGB cohort were more likely to require further subsequent surgical intervention for GP (23.1% vs. 3.7%, p=0.04). At last follow-up, GP symptom scoring as measured by the Gastroparesis Cardinal Symptom Index were 2.4 and 2.5 following RYGB and gastrectomy, respectively.

Conclusions: Gastrectomy with Roux-en-Y reconstruction was associated with greater perioperative morbidity compared to RYGB. Long-term symptomatic improvement was equivalent following either procedure. Patients undergoing RYGB were more likely to require subsequent surgical intervention, suggesting that gastrectomy may be a more definitive operation for the management of medically refractory gastroparesis.