Abstract
Background
Gastroparesis is a chronic digestive disorder with symptoms of nausea, vomiting, bloating, and abdominal pain resulting in a poor quality of life. Surgeons are increasingly asked to treat patients with gastroparesis as medical options have become limited due to safety concerns of many prokinetics. Surgical options include gastric stimulator implantation, sub-total gastrectomy, and pyloroplasty. We report our experience with minimally invasive pyloroplasty as sole surgical treatment for adult gastroparesis.
Materials and Methods
A retrospective review of prospectively collected data of 28 patients who underwent minimally invasive pyloroplasty alone as treatment for gastroparesis from Jan 2007 to Sept 2010. Pre- and postoperative symptom severity score (SSS), gastric emptying scintigraphy (GES), and medication use were reviewed.
Results
A laparoscopic Heineke–Mikulicz pyloroplasty was performed in 26 patients. A laparoscopic assisted, flexible trans-oral endoscopic circular stapled pyloroplasty was used in two patients. Prokinetic use was significantly reduced from 89% to 14% (p = <0.0001). The mean GES T1/2 decreased from 320 to 112 min (p = 0.001) and normalized in 71%. Significant improvements in the SSS were seen at 1 month for nausea (p = <0.0001), vomiting (p = <0.0001), bloating (p = 0.0023), abdominal pain (p = <0.0001), and gastroesophageal reflux disease (GERD) symptoms (p = 0.0143). Significant improvement persisted at 3 months for nausea (p = <0.0001), vomiting (p = <0.0001), bloating (p = 0.0004), abdominal pain (p = 0.0001) and GERD symptoms (p = 0.013). The average length of stay was 3.71 days. Overall, 83% of patients’ indicated that they saw improvement at 1 month follow-up.
Conclusion
Minimally invasive pyloroplasty provides excellent outcomes for patients with gastroparesis and should be considered as a primary treatment along with diet and medications as it is effective and does not eliminate the option for additional surgical options in the future for refractory disease. With technological advancements, a totally endoscopic pyloroplasty may be a less invasive option.
Similar content being viewed by others
References
Perkel M, Moore C, Hersh T, Davidson E. Metoclopramide therapy in patients with delayed gastric emptying: a randomized, double-blind study. Dig Dis Sci 1979;24(9):662–6.
FDA Announces Discontinued Marketing of GI Drug, Zelnorm, for Safety Reasons. . In: Administration D, editor.2007.
Tonini M, Cipollina L, Poluzzi E, Crema F, Corazza GR, De Ponti F. Review article: clinical implications of enteric and central D2 receptor blockade by antidopaminergic gastrointestinal prokinetics. . Aliment Pharmacol Ther. 2004;19(4):379–90.
Gheuens J. Propulsid (cisapride) Dear Healthcare Professional Letter. Janssen Pharmaceutica 2000.
How to Obtain Domperidone. . In: Information FDA-DoD, editor.2008.
Bromer MQ, Friedenberg F, Miller LS, Fisher RS, Swartz K, Parkman HP. Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. . Gastrointest Endosc 2005;61(7):833–9.
Ezzeddine D, Jit R, Katz N, Gopalswamy N, Bhutani MS. Pyloric injection of botulinum toxin for treatment of diabetic gastroparesis. . Gastrointest Endosc 2002;55(7):920–3.
Miller LS, Szych GA, Kantor SB, Bromer MQ, Knight LC, Maurer AH, et al. Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle. Am J Gastroenterol 2002;97(7):1653–60.
Binswanger R, Aeberhard P, Walther M, Vock P. Effect of pyloroplasty on gastric emptying: long term results as obtained with a labelled test meal 14–43 months after operation. Br J Surg 1978;65(1):27–9.
Khajanchee YS, O’Rourke RW, Lockhart B, Patterson EJ, Hansen PD, Swanstrom LL. Postoperative symptoms and failure after antireflux surgery. Arch Surg. 2002 Sep;137(9):1008–13; discussion 13–4
Potter S, Spiro S, Nance F. An alternative method to traditional pyloroplasty using a circular stapler. J am coll surg. 1995;180(6):742–4.
Søreide K, Sarr MG, Søreide JA. Pyloroplasty for benign gastric outlet obstruction—indications and techniques. . Scand J Surg 2006;95(1):11–6.
Jones M, Maganti K. A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol. 2003;98(10):2122–9.
Forstner-Barthell A, Murr M, Nitecki S, Camilleri M, Prather C, Kelly K, et al. Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg. 1999;3(1):15–21.
Reardon T, Schnell G, Smith O, Schubert T. Surgical Therapy for Gastroparesis. J Clin Gastroenterol. 1989;11(2):204–7.
McCallum R, Chen J, Lin Z, Schirmer B, Williams R, Ross R. Gastric pacing improves emptying and symptoms in patients with gastroparesis. . Gastroenterology. 1998;114(3):456–61.
Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008 Mar;103(3):753–63.
Abell T, Van Cutsem E, Abrahamsson H, Huizinga J, Konturek J, Galmiche J, et al. Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion. 2002;66(4):204–12.
Abell T, Bernstein R, Cutts T, Farrugia G, Forster J, Hasler W, et al. Treatment of gastroparesis: a multidisciplinary clinical review. Neurogastroenterol Motil. 2006;18(4):263–83.
Ayinala S, Batista O, Goyal A, Al-Juburi A, Abidi N, Familoni B, et al. Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis. Gastrointest Endosc 2005;61(3):455–61.
Gourcerol G, Leblanc I, Leroi AM, Denis P, Ducrotte P. Gastric electrical stimulation in medically refractory nausea and vomiting. European Journal of Gastroenterology and Hepatology. 2007;19:29–35.
Houghton L, Read N, Heddle R, Horowitz M, Collins P, Chatterton B, et al. Relationship of the motor activity of the antrum, pylorus, and duodenum to gastric emptying of a solid-liquid mixed meal. Gastroenterology. 1988;94(6):1285–91.
Cullen J, Kelly K. Functional characteristics of canine pylorus in health, with pyloroplasty, and after pyloric reconstruction. Dig Dis Sci. 1996;41(4):711–9.
Rachlin L. Vagotomy and Heineke-Mikulicz pyloroplasty in the treatment of pyloric stenosis. Am Surg 1970;36(4):251–3.
Johnson D. The past and present of antireflux surgery in children. Am J Surg. 2000;180(5):377–81.
Jawaid W, Abdalwahab A, Blair G, Skarsgard E, Webber E. Outcomes of pyloroplasty and pyloric dilatation in children diagnosed with nonobstructive delayed gastric emptying. J Pediatr Surg 2006;41(12):2059–61.
Danikas D, Geis W, Ginalis E, Gorcey S, Stratoulias C. Laparoscopic pyloroplasty in idiopathic hypertrophic pyloric stenosis in an adult. JSLS. 2000;4(2):173–5.
Khajanchee YS, Dunst CM, Swanstrom LL. Outcomes of Nissen fundoplication in patients with gastroesophageal reflux disease and delayed gastric emptying. Arch Surg. 2009 Sep;144(9):823–8.
Masqusi S, Velanovich V. Pyloroplasty with fundoplication in the treatment of combined gastroesophageal reflux disease and bloating. World J Surg. 2007 Feb;31(2):332–6.
Davis C, Jellish W, Fisichella P. Laparoscopic fundoplication with or without pyloroplasty in patients with gastroesophageal reflux disease after lung transplantation: how I do it. J Gastrointest Surg. 2010; 14(9):1434–41.
Muensterer O, Adibe O, Harmon C, Chong A, Hansen E, Bartle D, et al. Single incision laparoscopic pyloromyotomy. Surg Endosc. 2009;24(7):1589–93.
Park P, Bergström M, Ikeda K, Fritscher-Ravens A, Mosse S, Kochman M, et al. Endoscopic pyloroplasty with full-thickness transgastric and transduodenal myotomy with sutured closure. Gastrointest Endosc. 2007;66(1):116–20.
Revicki D, Rentz A, Dubois D, Kahrilas P, Stanghellini V, Talley N, et al. Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther. 2003;18(1):141–50.
Tougas G, Chen Y, Coates G, Paterson W, Dallaire C, Pare P, et al. Standardization of a simplified scintigraphic methodology for the assessment of gastric emptying in a multicenter setting. Am J Gastroenterol. 2000 Jan;95(1):78–86.
Mayo W. A Review of Five Hundred Cases of Gastro-Enterostomy, including Pyloroplasty, Gastroduodenostomy, and Gastrojejunostomy. Ann Surg 1905;42(5):641–55.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hibbard, M.L., Dunst, C.M. & Swanström, L.L. Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement. J Gastrointest Surg 15, 1513–1519 (2011). https://doi.org/10.1007/s11605-011-1607-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11605-011-1607-6