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Sleeve gastrectomy for treatment of delayed gastric emptying—indications, technique, and results

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Abstract

Introduction

Delayed gastric emptying (DGE) can be caused by gastric motility disorders such as gastroparesis with idiopathic background, diabetic neuropathy, or postsurgical nerve damage. Currently, a variety of endoscopic and surgical treatment options are available. We noted clinical improvement of gastric emptying with reduction of the gastric fundus following both fundoplication and fundectomy. As a consequence, we explored the effect of sleeve gastrectomy on gastric emptying. The focus of this paper is to investigate the role of laparoscopic sleeve gastrectomy (LSG) in the treatment of gastroparesis.

Methods

Patients with symptoms suggestive of gastroparesis received diagnostic work-up (gastric emptying scintigraphy and/or Radiographic Barium-Sandwich Emptying studies). Patients with fundic emptying problems and moderate gastric dilation were selected for a LSG. All perioperative parameters were documented regarding patients characteristics, complications, and outcomes expressed as symptoms and quality of life (GIQLI gastrointestinal quality of life index). Assessment of DGE: Barium Emptying Radigraphy Index (BERI) 0–5.

Results

From 122 patients with gastroparesis, 19 patients were selected for LSG (mean age 54 years (23–68); 10 males/9 females. Morbidity 2/19; no mortality; follow-up mean 24 months (12–60); preop/postop: BERI: 2, 31/1, 27 (p < 0.01); we noted significant improvement of the quality of life (preoperative GIQLI 78 (44–89)) to postoperative values of 114 (range 87–120) (p < 0.0001). Preoperative median BMI of these 19 patients was 24 [1–10], which was not significantly changed in the 15 patients at > 1 year follow-up with 23 [1–8]. Postoperative recurrence of DGE occurred in 3 patients who were reoperated after >1 year follow-up.

Conclusion

LSG is a potential surgical treatment option for selected patients with gastroparesis and fundic emptying problems.

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Authors and Affiliations

  1. Department of Surgery, Center for the Future of Surgery, University of California San Diego, 9500 Gilman Drive, MC: 0740, La Jolla, CA, 92093, USA

    Arielle Marian Lee, Karl-Hermann Fuchs, Kai Neki, Ryan Broderick & Santiago Horgan

  2. Department of General and Viszeral-Surgery, AGAPLESION Markus Krankenhaus, Frankfurt am Main, Germany

    Gabor Varga & Wolfram Breithaupt

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  1. Arielle Marian Lee
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  2. Karl-Hermann Fuchs
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  4. Wolfram Breithaupt
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  7. Santiago Horgan
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Contributions

Study conception and design: K.H. Fuchs and G. Varga. Acquisition of data: K.H. Fuchs, G. Varga, and W. Breithaupt. Analysis and interpretation of data: A.M. Lee, K.H. Fuchs, K. Neki, R. Broderick, and S. Horgan. Drafting: A.M. Lee, K.H. Fuchs, K. Neki, R. Broderick, and S. Horgan. Critical revision: A.M. Lee, K.H. Fuchs, K. Neki, R. Broderick, and S. Horgan.

Corresponding author

Correspondence to Karl-Hermann Fuchs.

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The study has been approved by the appropriate institutional review board and has therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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The authors declare that they have no conflict of interest.

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Lee, A.M., Fuchs, KH., Varga, G. et al. Sleeve gastrectomy for treatment of delayed gastric emptying—indications, technique, and results. Langenbecks Arch Surg 405, 107–116 (2020). https://doi.org/10.1007/s00423-020-01856-5

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