Roux-en-Y gastric bypass as a salvage solution for severe and refractory gastroparesis in malnourished patients.

Abstract

BACKGROUND:

Gastroparesis (GP) is a rare condition for which several symptomatic treatments are available, but they may fail, leading to a discussion of gastrectomy. Few studies have described gastric-preserving surgery, particularly in malnourished patients.

OBJECTIVE:

To describe the treatment of severe refractory GP with Roux-en-Y gastric bypass (RYGB).

SETTING:

A university center.

METHODS:

A retrospective review was conducted of adult patients who underwent laparoscopic RYGB. Severity and frequency of GP symptoms were compared before and 1 year after surgery using the Gastroparesis Cardinal Symptom Index (GCSI) score (0-5), the vomiting (VM) score (0-4), and the visual analog scale (VAS) for abdominal pain.

RESULTS:

Of the 9 patients with refractory GP, 7 were malnourished and 2 had obesity. There were no postoperative deaths. One patient was operated on for internal hernia without bowel necrosis. The mean GCSI score decreased significantly from 3.6 (range: 1-5) preoperatively to 2.1 (range: .3-4.4) postoperatively (P = .0019). The mean VM score improved significantly after surgery, from .22 (range: 0-1 units) preoperatively to 2.55 (range: 1-4) postoperatively (P = .007). The mean VAS score also decreased significantly from 7.0 (range: 5-9) preoperatively to 2.44 (range: 0-7) postoperatively (P = .0015). A nonsignificant weight and albumin change was observed at 1 year postoperatively, with a tendency for weight regain in malnourished patients.

CONCLUSION:

In malnourished patients with severe and refractory GP, this study suggests the feasibility, safety, and efficacy of RYGB for the treatment of vomiting and abdominal pain.

• Authors: David Moszkowicz, Germano Mariano, Heithem Soliman, Daniela Calabrese, Benoit Coffin, Henri Duboc
• Journal: Surgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery (Surg Obes Relat Dis) Vol. 18 Issue 5 Pg. 577-580 (05 2022) ISSN: 1878-7533 [Electronic] United States
• PMID: 35221251 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 American Society for Bariatric Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Abdominal Pain (etiology, surgery)
• Adult
• Gastrectomy
• Gastric Bypass
• Gastroparesis (complications, surgery)
• Humans
• Laparoscopy
• Malnutrition (complications, surgery)
• Obesity, Morbid (complications, surgery)
• Retrospective Studies
• Treatment Outcome
• Vomiting