Gastrectomy for gastroparesis: when and how

Abstract

: Gastroparesis is a chronic and debilitating gastric motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. The disease is frequently refractory to medical therapies, and multiple surgical options exist to treat medically refractory gastroparesis. However, a formal management algorithm has yet to be agreed upon. Furthermore, the best utilization and approach for the most extreme surgical option, gastrectomy, continues to be debated. This review article presents our surgical treatment algorithm and provides an overview of the literature surrounding various surgical options currently used in practice including gastric electrical stimulation, pyloroplasty, per-oral pyloromyotomy (POP), enteral feeding tubes, and sleeve gastrectomy. We additionally take a deeper look at the end of the line surgical therapy, gastrectomy, in an attempt to answer the question of when and how this definitive surgery should be utilized. While a gastrectomy is an extreme surgical treatment modality, for patients who fail less invasive surgical measures, gastrectomy often has favorable results in controlling symptoms and improving patients’ quality of life with an acceptable morbidity rate. However, gastrectomy should only be considered after exhausting all organ-sparing options. While there is no “one size fits all” surgical treatment modality for refractory gastroparesis, our recommendation for a definitive operation for medically refractory gastroparesis is a laparoscopic or robotic subtotal gastrectomy with a Roux-en-Y gastrojejunostomy reconstruction.