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.