Ryan Fairley, DO1, Danial Cottam, MD2, Helmuth T Billy, MD3. 1Community Memorial Hospital of SanBuenaventura, 2Bariatric Medicine Institute, Salt Lake City Utah, 3Ventura Advanced Surgical Associates, Ventura, California
Background: Gastroparesis is a chronic disorder that significantly impairs the quality of life in affected patients. Surgical options for patients that have failed medical management include placement of a gastric tube, insertion of a gastric stimulator, pyloroplasty and subtotal gastrectectomy. Enhanced gastric emptying has been shown to occur following sleeve gastrectomy in morbidly obese individuals. In this study, we combined laparoscopic sleeve gastrectomy with pyloroplasty for treatment of patients presenting with endstage gastroparesis .
Methods: A retrospective review of adult patients presenting with end stage gastroparesis recalcitrant to further medical therapy. Three patients who underwent laparoscopic sleeve gastrectomy with pyloroplasty were reviewed. Data collected from electronic medical records included patient demographics, gastric emptying studies, hospital records, and clinic visits. We reviewed postsurgical outcomes of disease severity and compared it to preoperative symptoms, gastric emptying and emergency department visits.
Results: Three patients diagnosed with severe, end stage, idiopathic or diabetic gastroparesis underwent sleeve gastrectomy with pyloroplasty. All had severely abnormal gastric emptying studies showing a half-life of greater than 1000 minutes . Chronic, recurrent access of the ED was apparent in all patients. Pre-operatively patient #1 had 24 ED visits with 21 admissions to evaluate abdominal pain, nausea, and vomiting, patient #2 had 14 ED visits with 10 admissions for abdominal pain, nausea, and vomiting, patient #3 had 11 ED visits with 2 admissions for abdominal pain and vomiting. Post-operative gastric emptying studies improved in all patients. Two patients had normal gastric emptying times. One patient had improvement in gastric emptying with a 90% reduction from the preoperative value. Postoperative visits to the emergency room for vomiting decreased in all patients. Patient #1 had 12 ED visits with 11 admissions(7 for nausea and vomiting and 4 for diabetic ketoacidosis). Patient #2 had 1 ED visit for vomiting that did not require an admission. Patient #3 had 16 ED visits with 4 admissions (1 for abdominal pain, 1 for nausea and vomiting, 1 for benzodiazepine overdose and 1 for pneumonia). Following sleeve gastrectomy and pyloroplasty all patients were discharged on a regular diet and were off of TPN and tube feedings.
Conclusions: Medically refractory gastroparesis is a significant clinical challenge. Sleeve gastrectomy with pyloroplasty may be a simpler and more reliable therapy vs other surgical treatments. Pyloroplasty and sleeve gastrectomy may improve quality of life for patients with severe medically refractory gastroparesis. Emergency department visits were decreased postoperatively.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88514
Program Number: P409
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster