Gastroparesis after Nissen Fundoplication

Jose from San Antonio sent us this question: “After a stomach emptying process at the beginning of 2020, the diagnosis was gastroparesis. I had a prior fundoplication in 2005. I was prescribed medication for the gastroparesis, to which I had allergic reactions to the Metoclopramide 10mg. I am still using the Ondansetron ODT 4mg for acute nausea, which helps but do not take away the nausea. I have found that ginger brings quick relieve, but it doesn’t last long. Over the last 3 months I have lost 30 lbs due to being nauseated consistently throughout the day, and would wake up at night, dry heaving. I eat several small meals throughout the day, and there are times that I eat nothing at all, as I would gag as I bring the food to my mouth. I am full after a few bites and stay full for long after. I also dry heave during the day. I am seeing my Endocrinologist monthly for type 2 Diabetes, Cholesterol, Hypothyroidism and Hypertension. Currently I am taking Synjardy XR 12.5mg-1000mg, 2 a day, Glimepiride 2g, 1 a day, and Ozempic 1mg per dose, 1 a week. I still have stomach emptying during the night, which makes my sugar spike when I least expect it. My endocrinologist suggests gastric pacemaker, but I declined based on what I read on your blog. My quality of life has gone down. Can I have the surgery to improve my health and just maybe reverse my Diabetes/High Cholesterol/Hypothyroidism. I also have osteoarthritis and will be having knee-replacement in December.”

Dear Jose,

Gastroparesis or delayed gastric emptying may develop in the setting of diabetes. Diabetic gastroparesis contributes to erratic blood sugar control in addition to debilitating symptoms like nausea, vomiting and abdominal pain. Medications like Metoclopramide, commonly known as Reglan, are used to promote gastric emptying. However, efficacy of Reglan is limited, and long-term use is associated with serious side effects. Gastric pacemakers are quite ineffective, and I do not recommend pacemaker placement for gastroparesis treatment.

An antrum preserving longitudinal gastrectomy along the greater curvature of the stomach is a promising procedure for treatment of gastroparesis. This approach was developed based on data from sleeve gastrectomy that show increased gastric emptying following gastric sleeve surgery for morbid obesity. I have personally tried the procedure in around 20 patients. All patients had immediate and complete gastroparesis related symptom resolution. Most importantly, longitudinal gastrectomy can be performed between the gastric antrum and fundoplication. Therefore, the fundoplication is preserved sparing you a potentially complicated revision surgery.

Other surgical option for gastroparesis treatment are available including pyloroplasty and gastric bypass surgery. However, in our own experience at Houston Weight Loss Surgery Center, we have found that a limited longitudinal gastrectomy to be the most effective and most reliable treatment for gastroparesis.