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Journal of Gastrointestinal Surgery

, Volume 13, Issue 5, pp 874–880 | Cite as

Results of Completion Gastrectomies in 44 Patients with Postsurgical Gastric Atony

  • James E. Speicher
  • Richard C. Thirlby
  • Joseph Burggraaf
  • Christopher Kelly
  • Sarah Levasseur
original article

Abstract

Introduction

Postsurgical gastric atony occurs infrequently after gastric surgery. However, the symptoms are disabling and refractory to medical management. The only effective treatment is completion gastrectomy. A few studies have examined in detail the long-term results of this radical procedure.

Methods

From 1988 through 2007, 44 patients (84% female, 16% male) underwent near-total or total completion gastrectomies for refractory postsurgical gastric atony. The average age was 52 (range 32–72). Gastric atony was documented using radionuclide solid food emptying studies. Charts were reviewed retrospectively to identify preoperative symptoms and long-term postoperative function, and the patients were contacted by phone to evaluate their current level of function.

Results

Of the original 44 patients, 66% (n = 29) were evaluated postoperatively at a mean of 5.6 + 4.5 years (range 0.5–15.0 years). Fourteen patients (32%) had died, and seven (16%) were lost to follow-up. Most common presenting symptoms were abdominal pain (98%), vomiting (98%), nausea (77%), diet limitation (75%), heartburn (64%), and weight loss (59%, average = 19% of BW). Postoperative complications occurred in 36% (n = 16), most commonly bowel obstruction (11%), anastomotic stricture (9%), and anastomotic leak (7%), and there was one perioperative death. At last follow-up, there were significant improvements in abdominal pain (97% to 59%, p < 0.001), vomiting (97% to 31%, p < 0.001), nausea (86% to 45%, p < 0.001), and diet limited to liquids or nothing at all (57% to 7%, p < 0.001). Some symptoms were more common postoperatively, including early satiety (24% to 89%, p < 0.001), and postprandial fullness (10% to 72%, p < 0.001). Average BMI at the time of surgery and at last follow-up were 23 and 21, respectively. Osteoporosis was diagnosed pre- and postoperatively in 17% and 67% of patients, respectively (p < 0.001). Seventy-eight percent of patients stated that they were in better health after surgery, while 17% were neutral, and 6% stated that they were worse off. Mean satisfaction with surgery was 4.7 (1–5 Likert scale).

Conclusion

Completion gastrectomies in this patient population resulted in significant improvements in abdominal pain, vomiting, nausea, and severe diet limitations. Most patients, however, have significant ongoing gastrointestinal complaints, and the incidence of osteoporosis is high. Patient satisfaction is high; about 78% of patients believed their health status is improved. We believe these data support the selective use of completion gastrectomies in patients with severe postsurgical gastroparesis.

Keywords

Gastroparesis Gastric atony Completion gastrectomy 

References

  1. 1.
    Clark CJ, Thirlby RC, Picozzi V Jr, Schembre DB, Cummings FP, Lin E. Current problems in surgery: gastric cancer. Curr Probl Surg 2006;43:566–670. doi: 10.1067/j.cpsurg.2006.06.003.PubMedCrossRefGoogle Scholar
  2. 2.
    Schirmer BD. Gastric atony and the Roux syndrome. Gastroenterol Clin North Am 1994;23:327–343.PubMedGoogle Scholar
  3. 3.
    Dong K, Yu XJ, Li B, Wen EG, Xiong W, Guan QL. Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatment. Chin J Dig Dis 2006;7:76–82. doi: 10.1111/j.1443-9573.2006.00255.x.PubMedCrossRefGoogle Scholar
  4. 4.
    Dong K, Li B, Guan QL, Huang T. Analysis of multiple factors of postsurgical gastroparesis syndrome after pancreaticoduodenectomy and cryotherapy for pancreatic cancer. World J Gastroenterol 2004;10:2434–2438.PubMedGoogle Scholar
  5. 5.
    Azpiroz F, Malagelada JR. Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology 1987;92:934–943.PubMedGoogle Scholar
  6. 6.
    Eckhauser FE, Conrad M, Knol JA, Mulholland MW, Colletti LM. Safety and long-term durability of completion gastrectomy in 81 patients with postsurgical gastroparesis syndrome. Am Surg 1998;64:711–716.PubMedGoogle Scholar
  7. 7.
    Hirao M, Fujitani K, Tsujinaka T. Delayed gastric emptying after distal gastrectomy for gastric cancer. Hepatogastroenterology 2005;52:305–309.PubMedGoogle Scholar
  8. 8.
    McAlhany JC Jr, Hanover TM, Taylor SM, Sticca RP, Ashmore JD Jr. Long-term follow-up of patients with Roux-en-Y gastrojejunostomy for gastric disease. Ann Surg 1994;219:451–455. doi: 10.1097/00000658-199405000-00002.PubMedCrossRefGoogle Scholar
  9. 9.
    Britton JP, Johnston D, Ward DC, Axon AT, Barker MC. Gastric emptying and clinical outcome after Roux-en-Y diversion. Br J Surg 1987;74:900–904. doi: 10.1002/bjs.1800741010.PubMedCrossRefGoogle Scholar
  10. 10.
    Pellegrini CA, Patti MG, Lewin M, Way LW. Alkaline reflux gastritis and the effect of biliary diversion on gastric emptying of solid food. Am J Surg 1985;150:166–171. doi: 10.1016/0002-9610(85)90027-3.PubMedCrossRefGoogle Scholar
  11. 11.
    Patterson DJ. Prokinetic agents in postgastrectomy patients. Gastroenterol Clin North Am 1994;23:313–325.PubMedGoogle Scholar
  12. 12.
    Forstner-Barthell AW, Murr MM, Nitecki S, Camilleri M, Prather CM, Kelly KA, Sarr MG. Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg 1999;3:15–21. discussion doi: 10.1016/S1091-255X(99)80003-1.PubMedCrossRefGoogle Scholar
  13. 13.
    Jones MP, Maganti K. A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 2003;98:2122–2129. doi: 10.1111/j.1572-0241.2003.07721.x.PubMedCrossRefGoogle Scholar
  14. 14.
    Eckhauser FE, Knol JA, Raper SA, Guice KS. Completion gastrectomy for postsurgical gastroparesis syndrome. Preliminary results with 15 patients. Ann Surg 1988;208:345–353. doi: 10.1097/00000658-198809000-00012.PubMedCrossRefGoogle Scholar
  15. 15.
    Karlstrom L, Kelly KA. Roux-Y gastrectomy for chronic gastric atony. Am J Surg 1989;157:44–49. doi: 10.1016/0002-9610(89)90418-2.PubMedCrossRefGoogle Scholar
  16. 16.
    Vogel SB, Woodward ER. The surgical treatment of chronic gastric atony following Roux-Y diversion for alkaline reflux gastritis. Ann Surg 1989;209:756–761. doi: 10.1097/00000658-198906000-00013.PubMedCrossRefGoogle Scholar
  17. 17.
    McCallum RW, Polepalle SC, Schirmer B. Completion gastrectomy for refractory gastroparesis following surgery for peptic ulcer disease. Long-term follow-up with subjective and objective parameters. Dig Dis Sci 1991;36:1556–1561. doi: 10.1007/BF01296397.PubMedCrossRefGoogle Scholar
  18. 18.
    Hinder RA, Esser J, DeMeester TR. Management of gastric emptying disorders following the Roux-en-Y procedure. Surgery 1988;104:765–772.PubMedGoogle Scholar
  19. 19.
    Farahmand M, Sheppard BC, Deveney CW, Deveney KE, Crass RA. Long-term outcome of completion gastrectomy for nonmalignant disease. J Gastrointest Surg 1997;1:182–187. doi: 10.1016/S1091-255X(97)80107-2.PubMedCrossRefGoogle Scholar
  20. 20.
    Gustavsson S, Kelly KA. Total gastrectomy for benign disease. Surg Clin North Am 1987;67:539–550.PubMedGoogle Scholar
  21. 21.
    Bradshaw BGG, Thirlby RC. The value of sham-feeding tests in patients with post-gastrectomy syndromes. Arch Surg 1993;128:982–987.PubMedGoogle Scholar
  22. 22.
    Meyer JH. Nutritional outcomes of gastric operations. Gastroenterol Clin North Am 1994;23:227–260.PubMedGoogle Scholar
  23. 23.
    Pol B, LeTreut YP, Hardwigsen J, Rosset E, Houvenaeghel G, Delpero JR. Mechanically stapled esophagojejunostomy. Results of a prospective series of 176 cases. Hepatogastroenterology 1997;44:458–466.PubMedGoogle Scholar
  24. 24.
    Viste A, Eide GE, Soreide O. Stomach cancer: a prospective study of anastomotic failure following total gastrectomy. Acta Chir Scand 1987;153:303–306.PubMedGoogle Scholar
  25. 25.
    Sannohe Y, Hiratsuka R, Doki K. Single layer suture by manual or mechanical stapling technique in esophagojejunostomy after total gastrectomy. Am J Surg 1981;142:403–406. doi: 10.1016/0002-9610(81)90361-5.PubMedCrossRefGoogle Scholar
  26. 26.
    Agaba EA, Shamseddeen H, Gentles CV, Sasthakonar V, Gellman L, Gadaleta D. Laparoscopic vs open gastric bypass in the management of morbid obesity: a 7-year retrospective study of 1,364 patients from a single center. Obes Surg 2008;18:1359–1363. doi: 10.1007/s11695-008-9455-5.PubMedCrossRefGoogle Scholar
  27. 27.
    Jones KB Jr, Afram JD, Benotti PN, Capella RF, Cooper CG, Flanagan L, Hendrick S, Howell LM, Jaroch MT, Kole K, Lirio OC, Sapala JA, Schuhknecht MP, Shapiro RP, Sweet WA, Wood MH. Open versus laparoscopic Roux-en-Y gastric bypass: a comparative study of over 25,000 open cases and the major laparoscopic bariatric reported series. Obes Surg 2006;16:721–727. doi: 10.1381/096089206777346628.PubMedCrossRefGoogle Scholar
  28. 28.
    Norman K, Pichard C, Lochs H, Pirlich M. Prognostic impact of disease-related malnutrition. Clin Nutr 2008;27:5–15. doi: 10.1016/j.clnu.2007.10.007.PubMedCrossRefGoogle Scholar
  29. 29.
    Ely JJ. Inadequate levels of essential nutrients in developed nations as a risk factor for disease: a review. Rev Environ Health 2003;18:111–129.PubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2009

Authors and Affiliations

  • James E. Speicher
    • 1
  • Richard C. Thirlby
    • 1
  • Joseph Burggraaf
    • 1
  • Christopher Kelly
    • 1
  • Sarah Levasseur
    • 1
  1. 1.Department of General, Thoracic, and Vascular SurgeryVirginia Mason Medical CenterSeattleUSA

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