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Introduction:
Gastroparesis is a chronic debilitating digestive disorder characterized by a delay in gastric emptying. Nausea, vomiting, abdominal pain, and bloating are characteristic of the disease and significantly affect the patient's quality of life. Medical therapy is limited to very few agents most of which are limited by their side effect profile. Various surgical techniques for the treatment of gastroparesis are invasive, not as effective, and have high complication rates. We describe our experience with laparoscopic pyloroplasty as a therapeutic alternative for the treatment of gastroparesis.

Patients and Methods:
22 patients with refractory gastroparesis were enrolled in this prospective study and underwent minimally invasive pyloroplasty. Pre- and postoperative gastric emptying study (GES), Gastroparesis Cardinal Symptom Index (GCSI©2003 Johnson & Johnson) , and complications were recorded.

Results:
21 patients underwent laparoscopic pyloroplasty and one patient was converted to open laparotomy. The mean duration of the procedure was 106 ± 25 minutes. The average length of stay was 2.9 ± 1.2 days. There were no major complications linked to the surgical procedure. At one month follow up, 16/22 (72.7%) patients noted overall improvement in their symptoms. At six months, 19/22 (86.3%) patients showed improvement in their GES. The GES results normalized in 18/22 (81.8%) patients at one year. The T1/2 decreased from 392 to 110 minutes (p=0.001). Significant improvements were noted on all items of the GCSI score at one year post-operative visit (table 1).

Conclusion:
Laparoscopic pyloroplasty is an effective, minimally invasive, and safe surgical alternative in patients with refractory gastroparesis who either fail or are intolerant of medical therapy. While our results are very promising, larger studies are needed to further evaluate its role.
Gastroparesis Cardinal Symptom Index (GCSI) pre and post-op data

Symptom	Pre-op score	Post-op score	p- value
Nausea	4.45	1.41	< 0.001
Retching	3.00	0.55	< 0.001
Vomiting	3.14	0.64	< 0.001
Fullness	4.73	2.32	< 0.001
Unable to finish a meal	4.41	1.55	< 0.001
Feeling full	4.68	2.05	< 0.001
Loss of appetite	4.41	1.36	< 0.001
Bloating	4.73	2.05	< 0.001
Stomach visibly bigger	3.73	1.45	< 0.001