Top

Published in:

01-02-2020 | Sleeve Gastrectomy | Original Article

Sleeve gastrectomy for treatment of delayed gastric emptying—indications, technique, and results

Authors: Arielle Marian Lee, Karl-Hermann Fuchs, Gabor Varga, Wolfram Breithaupt, Kai Neki, Ryan Broderick, Santiago Horgan

Published in: Langenbeck's Archives of Surgery | Issue 1/2020

Abstract

Introduction

Delayed gastric emptying (DGE) can be caused by gastric motility disorders such as gastroparesis with idiopathic background, diabetic neuropathy, or postsurgical nerve damage. Currently, a variety of endoscopic and surgical treatment options are available. We noted clinical improvement of gastric emptying with reduction of the gastric fundus following both fundoplication and fundectomy. As a consequence, we explored the effect of sleeve gastrectomy on gastric emptying. The focus of this paper is to investigate the role of laparoscopic sleeve gastrectomy (LSG) in the treatment of gastroparesis.

Methods

Patients with symptoms suggestive of gastroparesis received diagnostic work-up (gastric emptying scintigraphy and/or Radiographic Barium-Sandwich Emptying studies). Patients with fundic emptying problems and moderate gastric dilation were selected for a LSG. All perioperative parameters were documented regarding patients characteristics, complications, and outcomes expressed as symptoms and quality of life (GIQLI gastrointestinal quality of life index). Assessment of DGE: Barium Emptying Radigraphy Index (BERI) 0–5.

Results

From 122 patients with gastroparesis, 19 patients were selected for LSG (mean age 54 years (23–68); 10 males/9 females. Morbidity 2/19; no mortality; follow-up mean 24 months (12–60); preop/postop: BERI: 2, 31/1, 27 (p < 0.01); we noted significant improvement of the quality of life (preoperative GIQLI 78 (44–89)) to postoperative values of 114 (range 87–120) (p < 0.0001). Preoperative median BMI of these 19 patients was 24 [1–10], which was not significantly changed in the 15 patients at > 1 year follow-up with 23 [1–8]. Postoperative recurrence of DGE occurred in 3 patients who were reoperated after >1 year follow-up.

Conclusion

LSG is a potential surgical treatment option for selected patients with gastroparesis and fundic emptying problems.

Strong AT, Landreneau JP, Cline M, Kroh MD, Rodriguez JH, Ponsky JL, El-Hayek K (2019) Per-oral pyloromyotomy (POP) for medically refractory post-surgical gastroparesis. J Gastrointest Surg 23:1095–1103. https://doi.org/10.1007/s11605-018-04088-7 CrossRefPubMed

Jacques J, Pagnon L, Hure F, Legros R, Crepin S, Fauchais AL, Palat S, Ducrotté P, Marin B, Fontaine S, Boubaddi NE, Clement MP, Sautereau D, Loustaud-Ratti V, Gourcerol G, Monteil J (2019) Peroral endoscopic pyloromyotomy is efficacious and safe for refractory gastroparesis: prospective trial with assessment of pyloric function. Endoscopy 51(1):40–49. https://doi.org/10.1055/a-0628-6639 CrossRefPubMed

Maddern GJ, Jamieson GG (1985) Fundoplication enhances gastric emptying. Ann Surg 201:296–299CrossRef

Schwizer W, Hinder RA, DeMeester TR (1987) Does delayed gastric emptying contribute to gastroesophageal reflux disease? Am J Surg 157:74–81CrossRef

Urbain JL, Siegel JA, Charkes ND, Maurer AH, Malmud LS, Fisher RS (1989) The two-component stomach: effects of meal particle size on fundal and antral emptying. Eur J Nucl Med 15(5):254–259CrossRef

Fuchs KH, Maroske J, Fein M, Breithaupt W, Hammer I 2005 Laparoscopic sleeve gastrectomy for delayed gastric emptying, EAES abstract book

Fuchs KH, Breithaupt W, Varga G, Schulz T, Babic B 2015 Management of delayed gastric emptying. UEGW

Gagner M, Hutchinson C, Rosenthal R (2016) Fifth international consensus conference: current status of sleeve gastrectomy. Surg Obes Relat Dis 12(4):750–756. https://doi.org/10.1016/j.soard.2016.01.022 CrossRefPubMed

Fuchs KH, Musial F, Ulbricht F, Breithaupt W, Reinisch A, Schulz T, Babic B, Fuchs HF, Varga G (2017) Foregut symptoms, somatoform tendencies, and the selection of patients for antireflux surgery. Dis Esophagus 30:1–10CrossRef

10.

Eypasch E, Williams JI, Wood DS et al (1995) Gastrointestinal quality of life index: development, validation and application of a new instrument. Br J Surg 82:216–222CrossRef

11.

Horowitz M, Su YC, Rayner CK, Kl J (2001) Gastroparesis: prevalence, clinical significance and treatment. Can J Gastroenterol 15:805–813CrossRef

12.

Jung HK, Choung RS, Locke GR III, Schleck CD, Zinsmeister AR, Szarka LA, Mullan B, Talley NJ (2009) The incidence, prevalence and outcomes of patients with gastroparesis in Olmsted County, Minnesota from 1996–2006. Gastroenterology 136(4):1225–1233CrossRef

13.

Camillieri M, Parkman HP, Shafi MA, Abell TA, Gerson L (2013) American College of Gastroenterology Clinical guideline: management of gastroparesis. Am J Gastroenterol 108:18–37CrossRef

14.

Tack J, Van den Houte K, Carbone F (2018) Gastroduodenal motility disorders. Curr Opin Gastroenterol 34(6):428–435. https://doi.org/10.1097/MOG.0000000000000473 CrossRefPubMed

15.

Barr J, White RR (2019) Motility disorders of the stomach and small intestine. In: Yeo CJ, DeMeester SR, Fadden DWM (eds) Shackelford’s Surgery of the Alimentary Tract, 8th edn. Elsevier, Philadelphia, pp 755–763

16.

Ericson J, Sunde B, Lindblad M, Nilsson M, Lundell L, Tsai JA (2013) Large-diameter (30-35 mm) pneumatic balloon dilatation of the pylorus in patients with gastric outlet obstruction symptoms after esophagectomy. Scand J Surg 102(2):83–86. https://doi.org/10.1177/1457496913482254 CrossRefPubMed

17.

Lai N, Livemore S, Dunne D, Kahn I (2015) Gastric electrical stimulation with the enterra system: a systematic review. Gastroenterol Res Pract 2015:762972

18.

Hibbard MI, Dunst CM, Swanstrom LL (2011) Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg 15:1513–1519CrossRef

19.

Rodriguez J, Strong AT, Haskins IN, Landreneau JP, Allemang MT, El-Hayek K, Villamere J, Tu C, Cline MS, Kroh M, Ponsky JL (2018) Per-oral pyloromyotomy (POP) for medically refractory gastroparesis: short term results from the first 100 patients at a high volume center. Ann Surg 268(3):421–430. https://doi.org/10.1097/SLA.0000000000002927 CrossRefPubMed

20.

Fuchs KH, Breithaupt W, Schulz T, Reinisch A (2011) Experience with flexible stapling techniques in laparoscopic and conventional surgery. Surg Endosc 25:1783–1790CrossRef

21.

Zehetner J, Ravari F, Ayazi S, Skibba A, Iarehzereshki A, Pelipad D, Mason RJ, Katkhouda N, Lipham JC (2013) Minimally invasive surgical approach for the treatment of gastroparesis. Surg Endosc 27:61–66CrossRef

22.

Bhayani NH, Sharata AM, Dunst CM, Kurian AA, Reavis KM, Swanstrom LL (2015) End of the road for dysfunctional end organ: laparoscopic gastrectomy for refractory gastroparesis. J Gastrointest Surg 19:411–417CrossRef

23.

Abell TL, Van Cutsem E, Abrahamsson H, Huizinga JD, Konturek JW, Galmiche JP, VoelIer G, Filez L, Everts B, Waterfall WE, Domschke W, Bruley des Varannes S, Familoni BO, Bourgeois IM, Janssens J, Tougas G (2002) Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion 66(4):204–212CrossRef

24.

McCallum R, Lin Z, Wetzel P (2005) Clinical response to gastric electrical stimulation in patients with postsurgical gastroparesis. Clin Gastroenterol Hepatol 3:49–54CrossRef

25.

McCallum RW, Snape WJ, Brody F (2010) Gastric electrical stimulation with Enterra improves symptoms from diabetic gastroparesis in a prospective study. Clin Gastroenterol Hepatol 8:947–954CrossRef

26.

Mc Callum RW, Sarosiek I, Parkman HP, Snape W, Brody F, Wo J, Nowak T (2013) Gastric electrical stimulation with Enterra therapy improves symptoms of idiopathic gastroparesis. Neurogastroenterol Motil 25:815–e636

27.

Shada A, Nielsen A, Marowski S, Helm M, Funk LM, Kastenmeier A, Lidor A, Gould JC (2018) Wisconsin’s Enterra therapy experience: a multi-institutional review of gastric electrical stimulation for medically refractory gastroparesis. Surgery 164(4):760–765. https://doi.org/10.1016/j.surg.2018.04.043 CrossRefPubMed

28.

Shlomovitz E, Pescarus R, Cassera MA, Sharata AM, Reavis KM, Dunst CM, Swanstrom LL (2015) early human experience with per-oral endoscopic pyloromyotomy (POP). Surg Endosc 29:543–551CrossRef

29.

Fuchs KH, Babic B, Breithaupt W, Dallemagne B, Fingerhut A, Furnee E, Granderath F, Horvath OP, Kardos P, Pointner R, Savarino E, Van Herwarden-Lindeboom M, Zaninotto G (2014) EAES recommendations for the management of gastroesophageal reflux disease. Surg Endosc 28:1753–1773CrossRef

30.

Jobe BA, Richter JE, Hoppo T, Peters JH, Bell R, Dengler WC, DeVault K, Fass R, Gyawali CP, Kahrilas PJ, Lacy BE, Pandolfino JE, Patti MG, Swanstrom LL, Kurian AA, Vela MF, Vaezi M, DeMeester TR (2013) Preoperative diagnostic workup before antireflux surgery: an evidence and experience-based consensus of the esophageal diagnostic advisory panel. J Am Coll Surg 217(4):586–597. https://doi.org/10.1016/j.jamcollsurg.2013.05.023 CrossRefPubMed

31.

Maurer AH (2015) Gastrointestinal motility, part 1: esophageal transit and gastric emptying. J Nucl Med 56(8):1229–1238. https://doi.org/10.2967/jnumed.112.114314 CrossRefPubMed

32.

Keller J, Bassotti G, Clarke J, Dinning P, Fox M, Grover M, Hellström PM, Ke M, Layer P, Malagelada C, Parkman HP, Scott SM, Tack J, Simren M, Törnblom H, Camilleri M, International working group for disorders of gastrointestinal motility and function (2018) Expert consensus document: advances in the diagnosis and classification of gastric and intestinal motility disorders. Nat Rev Gastroenterol Hepatol 15(5):291–308. https://doi.org/10.1038/nrgastro.2018.7 CrossRefPubMedPubMedCentral

33.

Arthur LE, Slattery L, Richardson W (2018) Tailored approach to gastroparesis significantly improves symptoms. Surg Endosc 32(2):977–982. https://doi.org/10.1007/s00464-017-5775-7 CrossRefPubMed

34.

Wakamatsu K, Perez Quirante F, Montorfano L, Lo Menzo E, Seto Y, Rosenthal RJ (2018) Laparoscopic treatment of gastroparesis: a single center experience. Surg Obes Relat Dis 14(2):200–205. https://doi.org/10.1016/j.soard.2017.07.029 CrossRefPubMed

35.

Karlstrom L, Kelly KA (1989) Roux-Y gastrectomy for chronic gastric atony. Am J Surg 157:44–49CrossRef

36.

Forstner-Barthell AW, Murr MM, Nitecki S (1999) Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg 3:15–21CrossRef

37.

Sarosiek I, Davis B, Eichler E, McCallum RW (2015) Surgical approaches to treatment of gastroparesis: gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes. Gastroenterol Clin N Am 44(1):151–167. https://doi.org/10.1016/j.gtc.2014.11.012 CrossRef

38.

Landreneau JP, Strong AT, El-Hayek K, Tu C, Villamere J, Ponsky JL, Kroh MD, Rodriguez JH (2019) Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis. Surg Endosc 33(3):773–781. https://doi.org/10.1007/s00464-018-6342-6 CrossRefPubMed

39.

Gagner M, Rogula T (2003) Laparoscopic reoperative sleeve gastrectomy for poor weight loss after biliopancreatic diversion with duodenal switch. Obes Surg 13(4):649–654CrossRef

40.

Wangensteen OH (1957) Segmental gastric resection–an acceptable operation for peptic ulcer; tubular resection unacceptable. Surgery 41:686–690PubMed

41.

Hauss J, Spiegel HU, Langhans P, Bünte H 1988 Pyloric preserving longitudinal resection of the stomach-an ideal method of resection? Chirurg Forum f experimental u klin Forschung 432–436

42.

Spiegel HU, Skawran S (2011) From longitudinal gastric resection to sleeve gastrectomy--revival of a previously established surgical procedure. J Gastrointest Surg 15(1):219–228. https://doi.org/10.1007/s11605-010-1293-9 CrossRefPubMed

43.

Ignat M, Vix M, Imad I, D'Urso A, Perretta S, Marescaux J, Mutter D (2017) Randomized trial of roux-en-Y gastric bypass versus sleeve gastrectomy in achieving excess weight loss. Br J Surg 104(3):248–256. https://doi.org/10.1002/bjs.10400 CrossRefPubMed

44.

Nickel F, Schmidt L, Bruckner T, Billeter AT, Kenngott HG, Müller-Stich BP, Fischer L (2017) Gastrointestinal quality of life improves significantly after sleeve Gastrectomy and Roux-en-Y gastric bypass-a prospective cross-sectional study within a 2-year follow-up. Obes Surg 27(5):1292–1297. https://doi.org/10.1007/s11695-016-2464- CrossRefPubMed

45.

Lim AH, Schoeman MN, Nguyen NQ (2015) Long-term outcomes of direct percutaneous endoscopic jejunostomy: a 10-year cohort. Endosc Int Open 3(6):E610–E614. https://doi.org/10.1055/s-0034-1392806 CrossRefPubMedPubMedCentral

46.

Van Rijn S, Roebroek YGM, Conchillo JM, Bouvy ND, Masclee AAM (2016) Effect of vagus nerve injury on the outcome of antireflux surgery: an extensive literature review. Dig Surg 33:230–239CrossRef

47.

Zoll B, Zhao H, Edwards MA, Petrov R, Schey R, Parkman HP (2018) Outcomes of surgical intervention for refractory gastroparesis: a systematic review. J Surg Res 231:263–269. https://doi.org/10.1016/j.jss.2018.05.061 CrossRefPubMed

48.

Stenard F, Iannelli A (2015) Laparoscopic sleeve gastrectomy and gastroesophageal reflux. World J Gastroenterol 21(36):10348–10357. https://doi.org/10.3748/wjg.v21.i36.10348 CrossRefPubMedPubMedCentral

49.

Himpens J, Dobbeleir J, Peeters G (2010) Long-term results of laparoscopic sleeve gastrectomy for obesity. Ann Surg 252(2):319–324. https://doi.org/10.1097/SLA.0b013e3181e90b31 CrossRefPubMed

50.

DuPree CE, Blair K, Steele SR, Martin MJ (2014) Laparoscopic sleeve gastrectomy in patients with preexisting gastroesophageal reflux disease: a national analysis. JAMA Surg 149:328–334CrossRef

51.

Santonicola A, Angrisani L, Cuttolo P, Formisano G, Iovino P (2014) The effect of laparoscopic sleeve gastrectomy with or without hiatal hernia repair on GERD in obese patients. Surg Obes Relat Dis 10:250–255CrossRef

52.

Rebecchi F, Allaix ME, Giaccone C, Ugliono E, Scozzari G, Morino M (2014) GERD and laparoscopic sleeve gastrectomy: a physiologic evaluation. Ann Surg 260:909–914CrossRef

53.

Daes J, Rimenez ME, Said N, Dennis R (2014) Improvement of GERD symptoms after standardized laparoscopic sleeve gastrectomy. Obes Surg 24:536–540CrossRef

54.

Le Page PA, Martin D (2015) Laparoscopic partial sleeve gastrectomy with fundoplication for gastroesophageal reflux and delayed gastric emptying. World J Surg 39(6):1460–1464. https://doi.org/10.1007/s00268-015-2981-0 CrossRefPubMed

Title: Sleeve gastrectomy for treatment of delayed gastric emptying—indications, technique, and results
Authors: Arielle Marian Lee
Karl-Hermann Fuchs
Gabor Varga
Wolfram Breithaupt
Kai Neki
Ryan Broderick
Santiago Horgan
Publication date: 01-02-2020
Publisher: Springer Berlin Heidelberg
Keywords: Sleeve Gastrectomy
Gastrectomy
Gastric Fundoplication
Gastric Fundoplication
Motility Disorder
Motility Disorder
Gastrectomy
Published in: Langenbeck's Archives of Surgery / Issue 1/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01856-5

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Sleeve gastrectomy for treatment of delayed gastric emptying—indications, technique, and results

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2020

Pancreaticojejunostomy—a review of modern techniques

Gender comparison of clinical, histopathological, therapeutic and outcome factors in 185,967 colon cancer patients

Role of lymphadenectomy, adjuvant chemotherapy, and treatment at high-volume centers in patients with resected pancreatic cancer—a distinct view on lymph node yield

Development of a severe mesenteric traction syndrome during major abdominal surgery is associated with increased postoperative morbidity: Secondary data analysis on prospective cohorts

Surgical technique for placement of the automated low flow ascites pump (Alfapump)

Extended hepatic metastasectomy for renal cell carcinoma—new aspects in times of targeted therapy: a single-center experience over three decades