Introduction: Post-surgical gastroparesis occurs in less than 5% of patients undergoing gastric surgery. The symptoms, however, are disabling and refractory to medical management. The only effective surgical procedure is completion gastrectomy. Few studies have examined in detail the long term results of this radical procedure.
Methods: From 1988 through 2007, 44 patients (84% female, 16% male) underwent near-total or completion gastrectomies for refractory post-surgical gastroparesis by the same surgeon at a tertiary referral center. The average age was 52 (range 32-72). Gastroparesis was documented using a radionuclide solid food emptying study. Charts were reviewed retrospectively to identify preoperative symptoms and long term postoperative function, and the patients were contacted by phone to evaluate their current level of function.
Results: Of the original 44 patients, 57% (n=24) were evaluated postoperatively at a mean of 6.0 years (range 0.5 - 14.2 years). Fourteen patients (32%) had expired, and nine (20%) were lost to follow up. Presenting symptoms were abdominal pain (98%), vomiting (98%), nausea (77%), diet limitation (75%), heartburn (64%), and weight loss (59%, ave = 19% of BW). Postoperative complications occurred in 33%, most commonly bowel obstruction (9%), anastomotic stricture (9%), and anastomotic leak (7%), and there was one perioperative death, from leak leading to sepsis. At last follow up, there were significant improvements in abdominal pain (96% to 58%, p<0.01), vomiting (96% to 38%, p<0.01), nausea (83% to 46%, p<0.01), and diet limited to liquids or nothing at all (52% to 9%, p<0.01). Some symptoms were more common postoperatively: early satiety (25% to 93%, p<0.01), postprandial fullness (13% to 71%, p<0.01), bloating (25% to 43%, p=0.3), and diarrhea (38% to 42%, p=0.8). Average BMI was 23 prior to surgery and 21 at follow up. Osteoporosis was diagnosed pre- and postoperatively in 21% and 64% of patients, respectively (p<0.01). Seventy-one percent of patients stated that they were in better health after surgery, while 21% were neutral; mean satisfaction with surgery was 4.8 (1-5 Likert scale).
Conclusion: Completion gastrectomy in this patient population resulted in significant improvements in abdominal pain, vomiting, nausea, and severe diet limitations. Most patients, however, have ongoing gastrointestinal complaints and the incidence of osteoporosis is high. Regardless, patient satisfaction is very high and about 75% of patients believe their health status is improved. We believe these data support the selective use of completion gastrectomies in patients with severe post-surgical gastroparesis.