Abstract
Background
Gastroparesis (GP) is a rare condition for which several symptomatic treatments are
available, but they may fail, leading to a discussion of gastrectomy. Few studies
have described gastric-preserving surgery, particularly in malnourished patients.
Objective
To describe the treatment of severe refractory GP with Roux-en-Y gastric bypass (RYGB).
Setting
A university center.
Methods
A retrospective review was conducted of adult patients who underwent laparoscopic
RYGB. Severity and frequency of GP symptoms were compared before and 1 year after
surgery using the Gastroparesis Cardinal Symptom Index (GCSI) score (0–5), the vomiting
(VM) score (0–4), and the visual analog scale (VAS) for abdominal pain.
Results
Of the 9 patients with refractory GP, 7 were malnourished and 2 had obesity. There
were no postoperative deaths. One patient was operated on for internal hernia without
bowel necrosis. The mean GCSI score decreased significantly from 3.6 (range: 1–5)
preoperatively to 2.1 (range: .3–4.4) postoperatively (P = .0019). The mean VM score improved significantly after surgery, from .22 (range:
0–1 units) preoperatively to 2.55 (range: 1–4) postoperatively (P = .007). The mean VAS score also decreased significantly from 7.0 (range: 5–9) preoperatively
to 2.44 (range: 0–7) postoperatively (P = .0015). A nonsignificant weight and albumin change was observed at 1 year postoperatively,
with a tendency for weight regain in malnourished patients.
Conclusion
In malnourished patients with severe and refractory GP, this study suggests the feasibility,
safety, and efficacy of RYGB for the treatment of vomiting and abdominal pain.
Keywords
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Article info
Publication history
Published online: January 31, 2022
Accepted:
January 25,
2022
Received:
November 12,
2021
Identification
Copyright
© 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Comment on: Roux-en-Y gastric bypass as a salvage solution for severe and refractory gastroparesis in malnourished patientsSurgery for Obesity and Related DiseasesVol. 18Issue 5
- PreviewIn the current study, Moszkowicz et al. (2022) report their experience with Roux-en-Y gastric bypass (RYGB) in malnourished patients for the primary surgical indication of refractory gastroparesis [1]. Roux-en-Y for gastroparesis with or without gastrectomy has been in the surgical armamentarium for many years as a treatment for gastroparesis. Watkins et al. (2003) reported their experience with 7 patients undergoing gastrectomy with Roux-en-Y reconstruction with good immediate and long-term symptom resolution but high long-term morbidity in a at risk patient population with type 1 diabetes [2].
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