Indications for Concomitant Gastric Drainage Procedure and Foregut Surgery in the Laparoscopic Era
Abstracts
|
BACKGROUND: Patients undergoing foregut surgery for gastroesophageal reflux disease often present with symptoms attributed to delayed gastric emptying (DGE). This study seeks to clarify the role of a concomitant gastric drainage procedure during laparoscopic foregut surgery for patients with documented DGE. METHOD: We reviewed our database of all patients undergoing foregut surgery at a single institution. Patients with documented DGE were contacted for follow-up, specifically documenting symptoms of heartburn, regurgitation, dysphagia, bloating, and diarrhea. Data are reported as mean ? SEM. RESULTS: 1610 foregut procedures were performed for reflux at our institution over a 10-year period. Thirty-nine (2%) patients underwent a concomitant gastric drainage procedure, of which 31 of the 39 (80%) were performed laparoscopically (pyloroplasty = 27, pyloromyotomy = 4). Seven were performed through minilaparotomy after laparoscopic foregut procedure. The preoperative gastric half-emptying time of patients undergoing laparoscopic gastric drainage was 200 ? 29 minutes. There were no complications from the pyloric procedure regardless of approach. There was also no difference in operative times between the laparoscopic and open approaches (222 ? 12 vs. 279 ? 50, p = 0.1, respectively). All but one patient had significant improvement in DGE symptom scores postoperatively. No patients had dumping symptoms Mean follow-up time was greater than 15 months. CONCLUSIONS: Concurrent gastric drainage is necessary in a very small subset of patients undergoing foregut surgery. Both laparoscopic and open techniques for performing pyloromyotomy or pyloroplasty yield excellent results. |
