Laparoscopic Treatment of Gastroparesis: A Single Center Experience

A new study on gastroparesis treatment was recently accepted for publication in SOARD (Surgery for Obesity and related Disorders) journal. The study is a retrospective, single center, evaluation of 15 vs 73 patients who underwent gastric bypass vs gastric electric pacing surgery for treatment of medically refractory gastroparesis. The authors attempt to analyze the effectiveness of each procedure by studying post-operative symptom improvement and anti-emetic medication use. The results indicate nausea resolution but no improvement in vomiting and pain and no reduction in medication use following gastric bypass. Gastric electric pacing improved nausea, vomiting and abdominal discomfort but medication use did not change. Such finding suggests that symptoms did not really improve following gastric pacing and patients continued to require pro-kinetic and anti-emetic medications.

These results are in accordance with previously published literature. Randomized, prospective controlled GES showed no improvement in gastroparesis patients. RYGB is not well studied for gastroparesis treatment. In my personal experience, I have seen no improvement of gastroparesis symptoms following RYGB especially in severe and medically refractory cases. A longitudinal gastrectomy, on the other hand, that preserves the gastric antrum has been quite effective for gastroparesis treatment. I have had great success in my private practice treating around 10 patients with severe gastroparesis. All gastroparesis related symptoms completely resolved immediately following surgery with no readmission over more than one year follow up.

Gastroparesis incidence is rising and we still don’t have a good understanding of its pathophysiology. Most importantly, there is no established effective treatment guidelines for gastroparesis. Many gastroparesis patients are left untreated or poorly treated with symptoms that significantly diminish their quality of life and overall health. A multidisciplinary and serious effort is needed to study this disease to establish a treatment protocol. Studies like the one currently published in SOARD clearly show the ineffectiveness of gastric pacing and gastric bypass surgery for treatment of gastroparesis. The authors, however, seem hesitating confirming this observation and rather conclude that both procedure offer some degree of symptomatic improvement. Some degree of improvement is simply not enough when it comes to gastroparesis treatment.

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