Authors: Zhuo Sun John Rodriguez John McMichael Bipan Chand Deanne Nash Stacy Brethauer Phillip Schauer Kevin ElHayek Matthew Kroh
Publish Date: 2015/01/17
Volume: 29, Issue: 9, Pages: 2683-2689
Abstract
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 RouxenY gastrojejunostomy with or without neartotal gastrectomy RYGJ in morbidly obese patients with severe gastroparesisA 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 BMIA 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 followup During the average 23 months’ followup 9 patients 45 experienced at least one readmission for gastrointestinal reasons Early complications included two infections at a simultaneously placed Jtube site and one seroma In the RYGJ group all patients including 4 patients who failed GES and subsequently converted to RYGJ experienced shortterm symptom improvement and 5 patients 71 rated their symptoms as improved at last followup One duodenal stump leak happened in the RYGJ group There were no 30day mortalities in either group The BMI change after GES implantation was 06 ± 4 kg/m2 versus −77 ± 4 kg/m2 after RYGJ p 001GES 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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