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Back to 2014 Annual Meeting Abstracts
End of the Road for a Dysfunctional End-Organ: Gastrectomy for Refractory Gastroparesis
Neil Bhayani*1,2, Ahmed M. Sharata2, Christy M. Dunst2, Ashwin a. Kurian2, Kevin M. Reavis2, Lee L. Swanstrom2
1Providence Cancer Center, Portland, OR; 2Gastrointestinal & Minimally Invasive Surgery, The Oregon Clinic, Portland, OR
INTRODUCTION
Gastroparesis is a functional disorder resulting in debilitating nausea, overflow esophageal reflux & abdominal pain and is frequently refractory to medical treatment. Surgical therapies such as pyloroplasty and neurostimulators aim to facilitate emptying. When treatments to facilitate gastric emptying fail, subtotal gastrectomy has been employed with varying success. Herein, we examined outcomes after gastrectomy for diabetic and idiopathic gastroparesis.
METHODS
A prospective database was queried for gastrectomies with Roux-en-Y reconstruction performed for gastroparesis from 1993-2013. Primary outcomes were improvements in pre- versus post-operative symptoms at last followup, measured on a 5-point scale. Secondary outcome was operative morbidity.
RESULTS
Thirty-five patients underwent total or near-total gastrectomies for idiopathic (23%), post-operative(43%), or diabetic (34%) gastroparesis. Anti-emetics and pro-kinetics afforded no relief in 34.5% of patients. There were no operative mortalities. Six patients suffered a leak requiring anastomotic revision. With a median follow-up of 11.4 months, nausea improved or resolved in 70% after surgery. Chronic abdominal pain improved or resolved in 69% of patients. Belching and bloating resolved for 75% & 81%, respectively (p<0.01).
CONCLUSIONS
Regardless of etiology, medically-refractrory gastroparesis is a chronic and devastating disease. Surgery can ameliorate, and often relieve symptoms of nausea, excessive belching and gas bloat. Chronic abdominal pain commonly resolved or improved with resection. Despite attendant morbidity, gastrectomy can palliate symptoms of gastroparesis.
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