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PERIOPERATIVE OUTCOMES OF ROBOT-ASSISTED SIMULTANEOUS PYLOROPLASTY AND IMPLANTATION OF GASTRIC ELECTRICAL STIMULATION ARE SUPERIOR TO LAPAROTOMY IN DRUG REFRACTORY GASTROPARESIS: A TWO-CENTER STUDY
Brian R. Davis*1, Kent Van Sickle2, Azam Farukhi1, Colin P. Martyn1, Mohammad Bashashati1, Margaret Eastridge2, Joseph Chang2, Irene Sarosiek1, Richard W. McCallum1
1Texas Tech Health Sciences Center E, El Paso, TX; 2Surgery, University of Texas Health Sciences Center San Antonio, San Antonio, TX
Background: Gastroparesis (GP) is characterized by the presence of chronic, often debilitating gastrointestinal symptoms with delayed emptying of the stomach in the absence of mechanical obstruction, affecting about 10 million individuals in the US. Up to 30% of GP patients are refractory to medical therapy and are treated with gastric electrical stimulation (GES), resulting in an average of 50% improvement in symptoms. GES has minimal or no effect on the acceleration of gastric emptying. To overcome this deficiency, we added pyloroplasty (PP) to the procedure of implanting GES, which achieves up to 75% symptom improvement. This current study compares the perioperative outcomes of robot-assisted (RAS) versus laparotomy (LAP) techniques for simultaneous GES implantation and PP.
Methods: GP patients referred to 2 different GI surgery centers in the US from 2010 to 2016 were included. Simultaneous GES implantation and Heineke-Mikulicz PP were performed by either RAS or LAP. Perioperative outcomes based on duration of surgery, intra- and post-operative complications and duration of hospitalization after surgery were analyzed. Data is presented as mean ± SEM or frequency (%). Statistical comparison was performed using t- test or Chi-square.
Results: Overall, 44 and 12 patients had RAS or LAP, respectively. Thirty-two (72.7%) of RAS and 10 (84.0%) of LAP groups were women. Mean age of RAS group was not different compared to the LAP group. In the RAS and LAP groups, 33 (75.0%) and 8 (76.0%) were diabetics, respectively. Average days of hospitalization after surgery for RAS was statistically shorter than the LAP group (p=0.01); time to cessation of I.V. narcotics was shorter in the RAS group (p=0.001); time to initiation of P.O. narcotics was shorter in the RAS group (p<0.05); time to initiation of first oral liquids was comparable in both groups; time to initiation of GP diet was significantly shorter in the RAS group (p=0.01). Duration of surgery was significantly longer in the RAS compared to LAP group (p<0.001). Estimated blood loss in the RAS was significantly less than in the LAP group (p<0.0001). In the RAS and LAP groups: 8 (18.2%) and 6 (50.0%) received post-operative antibiotics (p<0.01) respectively; comparable numbers were discharged on short term oral narcotics 32 (72.7%) and 9 (75.0%). Post-op antiemetics were prescribed for 29 (65.9%) of RAS patients and all of LAP patients. No leaks or complications, including infections, were detected in the post-operative period.
Conclusions: In drug-refractory GP, the combination of GES and PP can be safely recommended for the robotic platform and has superior perioperative outcomes for hospital length of stay, dietary intake, and narcotic requirements compared to laparotomy technique. These improved perioperative outcomes set the stage for greater long term efficacy for simultaneous GES and PP.
Perioperative Outcomes of Robot-Assisted Simultaneous Pyloroplasty and Implantation of Gastric Electrical Stimulation Compared to Laparotomy
| | Robotic Surgery | Laparotomy | | Age at surgery (year) | 40.0±2.5 | 43.2 ±4.6 | | Duration of surgery (min) | 220.8±9.7 | 154.8±7.5 | | Estimated blood loss (cc) | 22.1±2.8 | 75.4±21.5 | | Duration of hospitalization after surgery (day) | 4.8±0.4 | 12.9±4.4 | | Time to cessation of I.V. narcotics (day) | 3.1±0.3 | 6.6±1.3 | | Time to initiation of P.O. narcotics (day) | 2.3±0.2 | 3.4±0.4 | | Time to initiation of first liquids (day) | 1.7±0.1 | 2.2±0.3 | | Time to initiation of GP diet (day) | 3.6±0.3 | 6.1±1.4 |
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