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Laparoscopic pyloroplasty is a safe and effective first-line surgical therapy for refractory gastroparesis

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Surgical options for symptomatic delayed gastric emptying include gastric stimulator implantation, subtotal gastrectomy, and pyloroplasty. Pyloroplasty has been shown to improve gastric emptying yet is seldom described as a primary treatment for gastroparesis. We present a single-institution experience of laparoscopic Heineke–Mikulicz pyloroplasty (LP) as treatment for gastroparesis.

Methods and Procedures

A prospective foregut surgery database was queried for LP over a 5-year period. Charts were reviewed for indications, complications, symptom score, and outcomes. Gastroparesis was defined by (1) abnormal gastric emptying study, (2) endoscopic visualization of retained food after prolonged NPO status, or (3) clinical symptoms suspicious of vagal nerve injury following complex re-operative foregut surgery. Results were analyzed using a paired T test and single-factor ANOVA.


One hundred and seventy-seven LP patients were identified and reviewed. One hundred and five had a concurrent fundoplication for objective reflux. There were no intraoperative complications or conversions to laparotomy. Overall morbidity rate was 6.8 % with four return to OR and two confirmed leaks (1.1 % leak rate). Average length of stay was 3.5 days, and readmission rate was 7 %. Eighty-six percent had improvement in GES with normalization in 77 %. Gastric emptying half-time decreased from 175 ± 94 to 91 ± 45 min. Nineteen patients (10.7 %) had subsequent surgical interventions: gastric stimulator implantation (12), feeding jejunostomy and/or gastrostomy tube (6), or subtotal gastrectomy (4). Symptom severity scores for nausea, vomiting, bloating, abdominal pain, and early satiety decreased significantly at 3 months.


Laparoscopic pyloroplasty improves or normalizes gastric emptying in nearly 90 % of gastroparesis patients with very low morbidity. It significantly improves symptoms of nausea, vomiting, bloating, and abdominal pain. Some patients may go on to another surgical treatment for GP, but it remains a safe and less invasive alternative to a subtotal gastrectomy in these clinically challenging patients.

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  1. Enweluzo C (2013) Gastroparesis: a review of current and emerging treatment options. Clin Exp Gastroenterol 5(6):161–165

    Article  Google Scholar 

  2. Bytzer P, Talley NJ, Leemon M, Young LJ, Jones MP, Horowitz M (2001) Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med 161:1989–1996

    Article  CAS  PubMed  Google Scholar 

  3. Oh JH, Pasricha PJ (2013) Recent advances in the pathophysiology and treatment of gastroparesis. J Neurogastroenterol Motil 19(1):18–24

    Article  PubMed  PubMed Central  Google Scholar 

  4. Hyett B, Martinez FJ, Gill BM, Mehra S, Lembo A, Kelly CP, Leffler DA (2009) Delayed radionucleotide gastric emptying studies predict morbidity in diabetics with symptoms of gastroparesis. Gastroenterology 137(2):445–452

    Article  PubMed  Google Scholar 

  5. Bielefeldt K (2012) Gastroparesis: concepts, controversies, and challenges. Scientifica 2012, Article ID 424802

  6. Hibbard ML, Dunst CM, Swanstrom LL (2011) Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg 15:1513–1519

    Article  PubMed  Google Scholar 

  7. Toro JP, Lytle NW, Patel AD, Davis SS, Christie JA, Waring JP, Sweeney JF, Lin E (2014) Efficacy of laparoscopic pyloroplasty for the treatment of gastroparesis. J Am Coll Surg 218(4):652–660

    Article  PubMed  Google Scholar 

  8. Khajanchee YS, Dunst CM, Swanstrom LL (2009) Outcomes of Nissen fundoplication in patients with gastroesophageal reflux disease and delayed gastric emptying. Arch Surg 144(9):823–828

    Article  PubMed  Google Scholar 

  9. Bremner CG (1968) Gastric drainage procedures: an experimental study. S Afr J Surg 6(3):113–123

    CAS  PubMed  Google Scholar 

  10. Bhayani NG, Sharata AM, Dunst CM, Kurian AA, Reavis KM, Swanstrom LL (2015) End of the road for a dysfunctional end organ: laparoscopic gastrectomy for refractory gastroparesis. J Gastrointest Surg 19(3):411–417

    Article  PubMed  Google Scholar 

  11. Zehetner J, Ravari F, Ayazi S, Skibba A, Darehzereshki A, Pelipad D, Mason RJ, Katkhouda N, Lipham JC (2013) Minimally invasive surgical approach for the treatment of gastroparesis. Surg Endosc 27(1):61–66

    Article  PubMed  Google Scholar 

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Correspondence to Christy M. Dunst.

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Amber Shada, Christy Dunst, Radu Pescarus, Emily Speer, Maria Cassera, Kevin Reavis, and Lee Swanstrom have no conflicts of interest or financial ties to disclose.


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Shada, A.L., Dunst, C.M., Pescarus, R. et al. Laparoscopic pyloroplasty is a safe and effective first-line surgical therapy for refractory gastroparesis. Surg Endosc 30, 1326–1332 (2016).

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