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Simultaneous Laparoscopic Pyloroplasty with Insertion of Gastric Stimulator is a Safe and Viable Palliative Option for Medically Refractory Gastroparesis

Ashwin A Kurian, MDD, Carolyn Dougherty. Denver Esophageal and Stomach Center

Introduction: Gastroparesis is a chronic gastric motility disorder defined by delayed gastric emptying and symptoms such as nausea, vomiting, bloating and abdominal pain. Surgical options for refractory gastroparesis include pyloroplasty, gastric stimulator insertion, and gastrectomy. The palliation from a pyloroplasty and gastric stimulator may be synergistic, however concerns remain regarding the possibility of stimulator infection when performing both procedures simultaneously. We present our initial experience of combined laparoscopic pyloroplasty and insertion of gastric stimulator.

Methods: Gastroparesis patients diagnosed by solid gastric scintigraphy or endoscopic evidence of retained food after prolonged NPO status who underwent combined laparoscopic Heineke-Mikulicz pyloroplasty and gastric stimulator insertion between July 2016 to July 2017 were reviewed.  Patient demographics, pre- and post-operative symptom scores and outcomes were collected. Results were analyzed using statistical tests as appropriate. P value < 0.05 were considered significant.

Results: Seven patients underwent the simultaneous pyloroplasty and gastric stimulator insertion. Six patients (86%) were idiopathic and one patient (14%) was diabetic. One patient was male and six patients were female. Mean age was 43±11.5 years and mean BMI was 26.7±3.6. All seven patients had failed medical management and all patients were naïve regarding surgical treatment for gastroparesis.

Median hospital stay was 2±1 days. No patients required readmission and no patients experienced immediate post-operative complications, especially gastric stimulator infection. Three patients required revision of the implant – two patients for recurrent symptoms with abnormal impedance readings and one patient for discomfort due to implant position.

Patient symptom scores did improve, although not significantly due to the low number of patients in this pilot study. Overall mean composite score [Gastropareis Cardinal Symptom Index: GCSI-2W] decreased from 3.3±0.61 to 2.98±0.83 (p value 0.4). Mean duration of follow-up was 5.8 months (1 month-14 months).

Conclusion: Combined laparoscopic Heineke-Mikulicz pyloroplasty with placement of gastric stimulator is a safe, minimally invasive procedure suitable for first line surgical treatment of refractory gastroparesis. No evidence of implant infection during the combined procedure was observed. Larger cohort studies are needed to evaluate the potential synergistic effect of simultaneous pyloroplasty and gastric stimulator insertion. 


Presented at the SAGES 2017 Annual Meeting in Houston, TX.

Abstract ID: 87132

Program Number: P468

Presentation Session: iPoster Session (Non CME)

Presentation Type: Poster

49

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