Pavlos K Papasavas1, Janet S Ng2, Andrea M Stone2, Olayemi A Ajayi3, Kiranmayi P Muddasani4, Darren S Tishler2. 1. Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut. Electronic address: pavlos.papasavas@hhchealth.org. 2. Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut. 3. University of Connecticut School of Medicine, Farmington, Connecticut. 4. Integrated General Surgery Residency, University of Connecticut, Farmington, Connecticut.
Abstract
BACKGROUND: Few treatments for idiopathic and diabetic gastroparesis exist beyond symptom management, and no study has described gastric surgery for gastroparesis in obese and morbidly obese patients. The objective of this study was to describe treatment of recalcitrant gastroparesis in obese adults with Roux-en-Y gastric bypass (RYGB) surgery. METHODS: A retrospective review was conducted of adult patients who underwent laparoscopic RYGB. Clinical data pre- and postsurgery and at a follow-up of up to 2 years were reviewed. Total symptom scores for gastroparetic symptom severity and frequency were compared presurgery and at follow-up using paired t tests. RESULTS: Seven obese and morbidly obese patients (body mass index [BMI] = 39.5, range = 33-54; 6 women) with idiopathic or diabetic gastroparesis reported marked symptom improvement, and total symptom scores significantly decreased after RYGB. All 4 patients who were taking prokinetics preoperatively no longer required their medication after surgery. Three patients required prolonged treatment with antinausea medications in the postoperative period. Mean BMI change was 9.1 units and mean percent excess weight lost was 71.6 lbs. No perioperative complications were experienced. Two required readmissions due to various concerns (dysphagia, nausea, anastomotic ulcer). CONCLUSIONS: In our cohort, no patients required the use of prokinetics after surgery and everyone experienced significant improvement in symptoms. Importantly, we found that RYGB is a safe surgical treatment for gastroparesis in obese patients. Our results indicate that gastroparesis, primarily believed to result in being underweight, can present in morbid obesity and can be markedly improved with RYGB.
BACKGROUND: Few treatments for idiopathic and diabetic gastroparesis exist beyond symptom management, and no study has described gastric surgery for gastroparesis in obese and morbidly obesepatients. The objective of this study was to describe treatment of recalcitrant gastroparesis in obese adults with Roux-en-Y gastric bypass (RYGB) surgery. METHODS: A retrospective review was conducted of adult patients who underwent laparoscopic RYGB. Clinical data pre- and postsurgery and at a follow-up of up to 2 years were reviewed. Total symptom scores for gastroparetic symptom severity and frequency were compared presurgery and at follow-up using paired t tests. RESULTS: Seven obese and morbidly obesepatients (body mass index [BMI] = 39.5, range = 33-54; 6 women) with idiopathic or diabetic gastroparesis reported marked symptom improvement, and total symptom scores significantly decreased after RYGB. All 4 patients who were taking prokinetics preoperatively no longer required their medication after surgery. Three patients required prolonged treatment with antinausea medications in the postoperative period. Mean BMI change was 9.1 units and mean percent excess weight lost was 71.6 lbs. No perioperative complications were experienced. Two required readmissions due to various concerns (dysphagia, nausea, anastomotic ulcer). CONCLUSIONS: In our cohort, no patients required the use of prokinetics after surgery and everyone experienced significant improvement in symptoms. Importantly, we found that RYGB is a safe surgical treatment for gastroparesis in obesepatients. Our results indicate that gastroparesis, primarily believed to result in being underweight, can present in morbid obesity and can be markedly improved with RYGB.
Authors: Joshua P Landreneau; Andrew T Strong; Kevin El-Hayek; Matthew D Kroh; John H Rodriguez Journal: Surg Endosc Date: 2019-07-11 Impact factor: 4.584
Authors: Ryan J Jalleh; Karen L Jones; Christopher K Rayner; Chinmay S Marathe; Tongzhi Wu; Michael Horowitz Journal: Diabetologia Date: 2022-10-04 Impact factor: 10.460
Authors: Joshua P Landreneau; Andrew T Strong; Kevin El-Hayek; Chao Tu; James Villamere; Jeffrey L Ponsky; Matthew D Kroh; John H Rodriguez Journal: Surg Endosc Date: 2018-07-17 Impact factor: 4.584