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BACKGROUND: Gastroparesis that is refractory to medical management is a debilitating disease. Patients battle chronic nausea, vomiting, abdominal pain and early satiety. In severe cases, these symptoms result in weight loss, malnutrition, and dependence on supplemental nutrition. The limited therapeutic options have resulted in a renewed interest in exploring surgical therapies for palliation of refractory gastroparesis. Gastric electrical stimulation (GES) has gained popularity due to initial reports of safety and efficacy. This study adds to the growing body of literature by describing our patients’ experiences and surgical outcomes with this GES.METHODS: Patients with gastroparesis were considered for GES after documented failure of medical management and documented delayed gastric emptying. All patients who underwent GES from March 2003 to September 2010 were included. Patient data was reviewed retrospectively.RESULTS: Thirty-nine patients had 44 gastric stimulators laparoscopically implanted during the study period. There were 12 patients with diabetic gastroparesis and 27 patients with idiopathic gastroparesis. Mean follow-up time was 21 months. Preoperatively, 27% of patients were dependent on supplemental nutrition (2 TPN, 8 tube feeds). After GES, 60% were able to eliminate all supplemental nutrition in a mean time of 5 months. Neither patient on TPN was able to eliminate the need for supplemental nutrition; however, both were able to transition from TPN to tube feeds. There were 13 complications that required operative intervention in 11 patients (30%). Complications included stimulator pack malposition (4/11), stimulator lead malfunction (2/11), stimulator pack malfunction (2/11), ventral hernia (2/11), stimulator infection (1/11), and bowel obstruction due to stimulator leads (1/11). Nine stimulators were explanted (4/9 battery failure, 2/9 malfunction, 2/9 foregut surgery requiring stimulator removal, 1/9 infection). Seven patients requiring stimulator explant elected to have their stimulator replaced. Two patients did not have adequate palliation with GES and elected to undergo subtotal gastrectomy.CONCLUSIONS: GES is an effective surgical intervention for eliminating reliance on supplemental nutrition in patients with refractory gastroparesis. Additionally, GES appears to facilitate the transition to enteral nutrition in patients who are TPN dependent. The incidence of surgical complications requiring operative intervention is significant and should be carefully considered prior to GES. All patients who required stimulator explant for a complication or battery failure elected to have their stimulator replaced suggesting that they felt stimulator benefits outweighed potential risks.