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Surgical Endoscopy
Published in: Surgical Endoscopy 9/2015

01-09-2015

Surgical treatment of medically refractory gastroparesis in the morbidly obese

Authors: Zhuo Sun, John Rodriguez, John McMichael, Bipan Chand, Deanne Nash, Stacy Brethauer, Phillip Schauer, Kevin El-Hayek, Matthew Kroh

Published in: Surgical Endoscopy | Issue 9/2015

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Abstract

Introduction

Surgical management of medically refractory gastroparesis remains a challenge. Case series and small retrospective studies describe clinical benefits from surgical intervention; however, no study reports the efficacy of gastric electrical stimulation (GES) or Roux-en-Y gastrojejunostomy with or without near-total gastrectomy (RYGJ) in morbidly obese patients with severe gastroparesis.

Methods

A chart review was performed on all morbidly obese patients (BMI > 35 kg/m2) who underwent GES or RYGJ for medically refractory gastroparesis from March 2002 to December 2012 at the Cleveland Clinic. The main outcomes examined were symptom improvement, postoperative complications, and change in BMI.

Results

A total of 20 morbidly obese patients underwent GES placement. Seven morbidly obese patients had RYGJ with or without resection of the remnant stomach surgery. All operations were completed laparoscopically. In GES group, 18 patients had initial symptom improvement (90 %) and 11 (55 %) rated their symptom improved at the last follow-up. During the average 23 months’ follow-up, 9 patients (45 %) experienced at least one readmission for gastrointestinal reasons. Early complications included two infections at a simultaneously placed J-tube site and one seroma. In the RYGJ group, all patients, including 4 patients who failed GES and subsequently converted to RYGJ, experienced short-term symptom improvement and 5 patients (71 %) rated their symptoms as improved at last follow-up. One duodenal stump leak happened in the RYGJ group. There were no 30-day mortalities in either group. The BMI change after GES implantation was 0.6 ± 4 kg/m2 versus −7.7 ± 4 kg/m2 after RYGJ (p < 0.01).

Conclusion

GES implantation and RYGJ are both effective in terms of symptom control for medically refractory gastroparesis in morbidly obese. Both options can be performed in a minimally invasive fashion with low morbidity. Patients who have no improvement of symptoms for refractory gastroparesis after GES implantation can be successfully converted laparoscopically to RYGJ.
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Metadata
Title
Surgical treatment of medically refractory gastroparesis in the morbidly obese
Authors
Zhuo Sun
John Rodriguez
John McMichael
Bipan Chand
Deanne Nash
Stacy Brethauer
Phillip Schauer
Kevin El-Hayek
Matthew Kroh
Publication date
01-09-2015
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 9/2015
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-014-3990-z

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