Completion gastrectomy for postsurgical gastroparesis syndrome. Preliminary results with 15 patients

Postsurgical gastroparesis syndrome (PGS) is a complex disorder characterized by postprandial nausea, vomiting, and gastric atony without evidence of mechanical gastric outlet obstruction. These symptoms can be disabling and are frequently unresponsive to drug therapy. Fifteen patients with documented PGS, including 13 women and two men, were recently treated by completion gastrectomy (CG) over a 5-year period. Gastric emptying study (GES) was markedly prolonged in 12 of the patients studied, and improved partially in only one patient (8%) with the administration of metoclopramide alone or combined with other gastrokinetic drugs. Patients were evaluated both before and after surgery, using a modified Visick rating system and a severity of symptoms (SS) score based on seven gastrointestinal (G.I.) and five systemic variables. All 15 patients underwent CG and reconstruction with a 50 cm Roux-en-Y limb. There were no operative deaths or complications related to the esophagojejunal anastomosis. Mean postoperative follow-up was 13.9 months, with a range of 2-65 months. After CG, the Visick rating and overall SS score improved significantly. The improvement in SS score was primarily due to a significant decrease in G.I. symptoms with little or no change in systemic symptoms. Overall, 86% of patients reported a satisfactory clinical result. CG, while seemingly radical, can be performed with low risk, and for properly selected patients with PGS, may be the treatment of choice.