|
Back to 2015 Annual Meeting Program
Retrospective Analysis of Pyloroplasty Outcomes After Improvement With Botulinum Toxin Injection in Post-Fundoplication Gastroparesis
Daniel Gilsdorf*1, Abbie V. Brickley2, Eric T. Volckmann1, Robert E. Glasgow1, John C. Fang2
1Department of Surgery, University of Utah, Salt Lake City, UT; 2Department of Internal Medicine, Division of Gastroenterology, Hepatology and Nutrition, University of Utah, Salt Lake City, UT
Background:
Endoscopic pyloric Botox injections can provide short-term symptom relief in patients with post-surgical gastroparesis, but responses are not durable. Surgical options including pyloroplasty can improve gastroparesis symptoms, but the choice of operation and patient selection criteria are poorly defined. We hypothesize that symptom improvement after Botox injection may help select candidates for surgical pyloroplasty in post-fundoplication gastroparesis.
Study design:
A retrospective chart review was performed of patients with post-fundoplication gastroparesis who underwent intrapyloric botulinum injection followed by pyloroplasty if symptoms improved after Botox injection. Preoperative and postoperative symptom data, gastric emptying studies (GES), medication use, and technical outcomes were reviewed.
Results:
Ten patients (from 2006-14) had symptom improvement after Botox injection ranging from mild improvement to complete resolution. All patients had prior fundoplication, and 50% had multiple previous foregut surgeries. A hand-sewn Heineke-Mikulicz pyloroplasty was performed in all 10. Three of 10 patients required conversion to open surgery. The median length of stay was 3 days. The mean operative time was 114 minutes (range 55-234 minutes). All patients had symptom follow up and 5/10 (50%) had postoperative GES. All patients had normalization of gastric emptying times with mean GES T1/2 decreasing from 220 to 58 min (p < 0.05). Prokinetic medications were discontinued in 3/5 patients post-pyloroplasty. Improvement in overall gastroparesis symptoms, including nausea, bloating, and post-prandial fullness, was reported in 9 of 10 patients at 3 month follow up. Three patients required subsequent foregut surgery for recurrent paraesophageal hernia. The one patient who did not improve after pyloroplasty underwent successful conversion to a Roux-en-Y bypass. Mean duration of follow up was 21.7 months (range 0.4 - 80.1 months).
Conclusion:
Heineke-Mikulicz pyloroplasty can offer symptomatic improvement and improved gastric emptying for patients with post-fundoplication gastroparesis. Symptomatic improvement after intra-pyloric Botox injection may help select patients for surgical therapy with pyloroplasty for refractory post-surgical gastroparesis.
Back to 2015 Annual Meeting Program
|
