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Objective: The management of chronic gastroparesis presents a challenge to both medical and surgical specialists. The role of surgery in patients with diabetic or idiopathic gastroparesis is not well defined in the literature. We present our experience with gastroparetic patients undergoing Roux-en-Y gastric bypass (RYGB) surgery.
Design: Retrospective case series.
Setting: Tertiary care facility
Patients: We present 5 patients who underwent laparoscopic RYGB and also carried the diagnosis of chronic gastroparesis. Three morbidly obese patients with diabetic gastroparesis underwent RYGB for morbid obesity; one patient had a gastric electrical stimulator in place, which was removed at the time of RYGB and one patient with BMI of 34 kg/m² was referred for a gastric electrical stimulator but elected to proceed with RYGB. Four patients with diabetic gastroparesis required insulin, and one patient had idiopathic gastroparesis. All patients required promotility and/or antiemetic medications. Preoperative BMI ranged from 34 to 54 Kg/m².
Interventions: All patients underwent laparoscopic RYGB.
Main Outcome Measures: Resolution of symptoms.
Results: At an average follow-up of 266 days (55-375 days) the mean weight loss was 79.6 lbs (28-138), and the mean decrease in BMI was 13.4 (5-25). There were no major complications. One patient developed stricture of the Roux limb that responded to endoscopic dilation. All patients experienced either resolution or significant improvement of gastroparesis symptoms and discontinued promotility agents.
Conclusions: RYGB is an effective treatment of gastroparesis in this small cohort of obese patients. Further study in the form of a prospective randomized trial is needed to determine both ideal patient selection and the efficacy of this treatment modality.