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INFECTION RATE IN PATIENTS AFTER ENTERRA DEVICE PLACEMENT WITH CONCURRENT PYLOROPLASTY
Tejasvi Paturu
*, Katherine Englander, Samer Ganam, Vic Velanovich, Joseph Sujka
GI Surgery, University of South Florida, Tampa, FL
IntroductionNeurostimulation and pyloroplasty are interventions to treat gastroparesis refractory to lifestyle changes, medication, and less invasive interventions. The Enterra
TM system (Enterra Medical, Inc., St. Louis Park, MN) is the only neurostimulation device currently approved in the treatment of gastroparesis. Some patients concurrently undergo pyloroplasty when the Enterra system is placed. To our knowledge, the risk of postoperative infection following Enterra device placement with concurrent pyloroplasty is not well studied. The primary aim of this study was to compare infection rates between patients who underwent Enterra placement with and without concurrent pyloroplasty.
Methods A retrospective chart review of 94 patients who underwent Enterra neurostimulator device placement between 2012 and 2023 at a tertiary care center was performed. Records were reviewed for whether the patient underwent concomitant pyloroplasty, if there was wound infection, and glycemic control (A1c level at the time of operation). Chi-squared analysis was used to assess the difference in infection rates with a significance rate at p?0.05.
Results Of the 94 patients with Enterra neurostimulator device placed, 28 patients underwent concurrent pyloroplasty while 66 patients did not. Of the patients who underwent concurrent pyloroplasty 7 (25%) sustained wound infection and of the patients who did not undergo concurrent pyloroplasty, 4 (6%) sustained wound infection (p=0.009). This suggests that there is an increased risk of infection with concurrent pyloroplasty. Glycemic control level (as measured by A1c) was not associated with a lower infection rate. Average A1c levels for patients without a wound infection was 7.6+/-1.5 and with a wound infection was 8.7+/-2.2 (p=0.17).
ConclusionThere was a significantly higher infection rate in patients who underwent a concurrent pyloroplasty during Enterra neurostimulator placement in comparison to those who did not. Though the average A1c level was greater in those patients who had wound infections, there was no statistically significant association between glycemic control and infection. These results suggest that the risk of infection in patients managed with the combined pyloroplasty and Enterra neurostimulator approach must be considered. Further research is also warranted to explore the factors contributing to the increased infection risk and the optimization of perioperative management strategies to prevent infection in this population. However, one alternative would be performing G-POEM instead of pyloroplasty when placing Enterra.
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