Joshua P Landreneau1,2, Andrew T Strong3,4, Kevin El-Hayek3,4, Matthew D Kroh3,4,5, John H Rodriguez3,4. 1. Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA. landrej@ccf.org. 2. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. landrej@ccf.org. 3. Department of General Surgery, Cleveland Clinic, Cleveland, OH, USA. 4. Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH, USA. 5. Digestive Disease Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.
Abstract
BACKGROUND: Gastroparesis is a debilitating functional disorder of the stomach marked by delayed gastric emptying in the absence of mechanical obstruction. Patients with severe, refractory symptoms may ultimately be managed with Roux-en-Y reconstruction; however, it is unclear whether the stomach should be left in situ, similar to a conventional gastric bypass, or resected as in gastrectomy. METHODS: All patients undergoing Roux-en-Y for the treatment of gastroparesis (GP) at our institution from September 2010 through March 2018 were retrospectively reviewed. Patients with prior gastric resection or whose primary operative indication was not gastroparesis were excluded from analysis. RESULTS: Twenty-six patients underwent Roux-en-Y with stomach left in situ (RY-SIS) and twenty-seven patients underwent gastrectomy with Roux-en-Y reconstruction during the study period. The mean age was 49.7 years in the RY-SIS cohort and 48.5 years in the gastrectomy cohort. Etiology of GP was similar between the two cohorts. Patients undergoing gastrectomy were more likely to have previous interventions for GP (63.0% vs. 26.9%). RY-SIS was associated with a shorter operative time (155 vs. 223 min), less blood loss (24 vs. 130 mL), and shorter length of stay (4.0 vs. 7.2 days). Twelve patients (44.4%) had complications within 30 days following gastrectomy compared to two patients (7.7%) following RY-SIS (p = 0.001). Patients in the RY-SIS cohort were more likely to require further subsequent surgical intervention for GP (23.1% vs. 3.7%, p = 0.04). At last follow-up, there were no differences in reported GP symptoms or symptom scoring. CONCLUSIONS: Gastrectomy was associated with greater perioperative morbidity compared to leaving the stomach in situ. Symptomatic improvement at intermediate follow-up was equivalent following either procedure. However, patients undergoing RY-SIS were more likely to require subsequent surgical intervention, suggesting that gastrectomy may be a more definitive operation for the management of medically refractory gastroparesis.
BACKGROUND:Gastroparesis is a debilitating functional disorder of the stomach marked by delayed gastric emptying in the absence of mechanical obstruction. Patients with severe, refractory symptoms may ultimately be managed with Roux-en-Y reconstruction; however, it is unclear whether the stomach should be left in situ, similar to a conventional gastric bypass, or resected as in gastrectomy. METHODS: All patients undergoing Roux-en-Y for the treatment of gastroparesis (GP) at our institution from September 2010 through March 2018 were retrospectively reviewed. Patients with prior gastric resection or whose primary operative indication was not gastroparesis were excluded from analysis. RESULTS: Twenty-six patients underwent Roux-en-Y with stomach left in situ (RY-SIS) and twenty-seven patients underwent gastrectomy with Roux-en-Y reconstruction during the study period. The mean age was 49.7 years in the RY-SIS cohort and 48.5 years in the gastrectomy cohort. Etiology of GP was similar between the two cohorts. Patients undergoing gastrectomy were more likely to have previous interventions for GP (63.0% vs. 26.9%). RY-SIS was associated with a shorter operative time (155 vs. 223 min), less blood loss (24 vs. 130 mL), and shorter length of stay (4.0 vs. 7.2 days). Twelve patients (44.4%) had complications within 30 days following gastrectomy compared to two patients (7.7%) following RY-SIS (p = 0.001). Patients in the RY-SIS cohort were more likely to require further subsequent surgical intervention for GP (23.1% vs. 3.7%, p = 0.04). At last follow-up, there were no differences in reported GP symptoms or symptom scoring. CONCLUSIONS: Gastrectomy was associated with greater perioperative morbidity compared to leaving the stomach in situ. Symptomatic improvement at intermediate follow-up was equivalent following either procedure. However, patients undergoing RY-SIS were more likely to require subsequent surgical intervention, suggesting that gastrectomy may be a more definitive operation for the management of medically refractory gastroparesis.
Authors: Andrew T Strong; Joshua P Landreneau; Michael Cline; Matthew D Kroh; John H Rodriguez; Jeffrey L Ponsky; Kevin El-Hayek Journal: J Gastrointest Surg Date: 2019-02-26 Impact factor: 3.452
Authors: Thomas L Abell; Michael Camilleri; Kevin Donohoe; William L Hasler; Henry C Lin; Alan H Maurer; Richard W McCallum; Thomas Nowak; Martin L Nusynowitz; Henry P Parkman; Paul Shreve; Lawrence A Szarka; William J Snape; Harvey A Ziessman Journal: Am J Gastroenterol Date: 2007-11-19 Impact factor: 10.864
Authors: Neil H Bhayani; Ahmed M Sharata; Christy M Dunst; Ashwin A Kurian; Kevin M Reavis; Lee L Swanstrom Journal: J Gastrointest Surg Date: 2015-01-10 Impact factor: 3.452
Authors: James E Speicher; Richard C Thirlby; Joseph Burggraaf; Christopher Kelly; Sarah Levasseur Journal: J Gastrointest Surg Date: 2009-02-18 Impact factor: 3.452
Authors: Pavlos K Papasavas; Janet S Ng; Andrea M Stone; Olayemi A Ajayi; Kiranmayi P Muddasani; Darren S Tishler Journal: Surg Obes Relat Dis Date: 2014-01-29 Impact factor: 4.734
Authors: Dennis A Revicki; Anne M Rentz; Dominique Dubois; Peter Kahrilas; Vincenzo Stanghellini; Nicholas J Talley; Jan Tack Journal: Qual Life Res Date: 2004-05 Impact factor: 4.147
Authors: Roman V Petrov; Charles T Bakhos; Abbas E Abbas; Zubair Malik; Henry P Parkman Journal: Gastroenterol Clin North Am Date: 2020-06-20 Impact factor: 3.806