Abstracts
1998 Digestive Disease Week

#3582

NEAR TOTAL GASTRECTOMY FOR SEVERE POSTVAGOTOMY GASTROPARESIS: CRITICAL ANALYSIS OF EARLY AND LATE LONG-TERM RESULTS AT A TERTIARY CENTER. AW Forstner-Barthell, MM Murr, S Nitecki, KA Kelly, M Camilleri, CM Prather, MG Sarr. Depts of Surgery and Internal Medicine, Mayo Clinic, Rochester, MN.

AIM: To evaluate critically results of completion gastrectomy as treatment for severe chronic postgastrectomy, post-vagotomy gastroparesis. METHODS: We reviewed our experience with 62 consecutive pts operated from 1985-1996. Follow-up was complete in 98% at 5.4 ± 0.5 yr ( ± SEM) with range 0.5-12 yr. Patients (51 women, 11 men) had a mean age of 48 ± 2 yr and were markedly symptomatic for 3 ± 0.5 yr preop; all had modified Visick score of 3 (37%) or 4 (63%). Weight loss preop was 12 ± 1 kg. Half had been hospitalized for malnutrition and required parenteral and/or enteral nutritional support. Symptoms included nausea (93%), vomiting (65%), postprandial pain (58%), chronic abdominal pain and chronic narcotic use (52%), diarrhea (36%), and dumping (29%). Gastroparesis, well documented by motility studies, delayed gastric emptying, and/or bezoars followed a mean of 4 previous gastric operations (range 1-12) for presumptive peptic ulcer (96%) or non-specific dyspeptic-like symptoms (4%); all had a prior vagotomy. Operative treatment was near total, completion gastrectomy with end-side Roux-en-Y cardiojejunostomy. RESULTS: There was no hospital mortality, but complications occurred in 37 pts (60%): narcotic withdrawal with concomitant pain (30%); prolonged ileus (16%); wound infection (8%); intestinal obstruction (3%); and anastomotic leak (8%) as detected by contrast study, only one of which required reoperation. At long-term followup,
43% have had all or most symptoms relieved (Visick grade 1 or 2), but 57% remain at a Visick grade of 3 or 4; 4% and 21% require parenteral or enteral nutritional support, resp. Overall nausea, vomiting, and/or postprandial pain were reduced to 50%, 32%, and 28%, resp (p<0.05), but chronic pain, diarrhea, and dumping were not significantly changed. When compared to those in Grade 1 or 2, pts who remained in Grade 3 or 4 were more likely to have had chronic pain preop (63 vs 46%) or have been dependent on opioids (60 vs 38%). SUMMARY: Gastroparesis is more common in women. Most or all symptoms were substantially relieved in only about half of pts; especially nausea, vomiting, and postprandial pain. CONCLUSIONS: Complete gastrectomy is successful in only 50% of pts with severe postvagotomy gastroparesis, especially in the absence of chronic pain and/or narcotic dependence. Because of persistent symptoms, concomitant jejunostomy tube placement is indicated.

Copyright 1996 - 1998, SSAT, Inc. Revised 29 June 1998.