title: Minimally invasive surgical approach for the treatment of gastroparesis.
abstract: BACKGROUND
  Gastroparesis is a chronic disorder resulting in decreased quality of life. The gastric electrical stimulator (GES) is an alternative to gastrectomy in patients with medically refractory gastroparesis. The aim of this study was to analyze the outcomes of patients treated with the gastric stimulator versus patients treated with laparoscopic subtotal or total gastrectomy.
  
  
  METHODS
  A retrospective chart review was performed of all patients who had surgical treatment of gastroparesis from January 2003 to January 2012. Postoperative outcomes were analyzed and symptoms were assessed with the Gastroparesis Cardinal Symptom Index (GCSI).
  
  
  RESULTS
  There were 103 patients: 72 patients (26 male/46 female) with a GES, implanted either with laparoscopy (n = 20) or mini-incision (n = 52), and 31 patients (9 male/22 female) who underwent laparoscopic subtotal (n = 27), total (n = 1), or completion gastrectomy (n = 3). Thirty-day morbidity rate (8.3% vs. 23%, p = 0.06) and in-hospital mortality rate (2.7% vs. 3%, p = 1.00) were similar for GES and gastrectomy. There were 19 failures (26%) in the group of GES patients; of these, 13 patients were switched to a subtotal gastrectomy for persistent symptoms (morbidity rate 7.7%, mortality 0). In total, 57% of patients were treated with GES while only 43% had final treatment with gastrectomy. Of the GES group, 63% rated their symptoms as improved versus 87% in the primary gastrectomy group (p = 0.02). The patients who were switched from GES to secondary laparoscopic gastrectomy had 100% symptom improvement. The median total GCSI score did not show a difference between the procedures (p = 0.12).
  
  
  CONCLUSIONS
  The gastric electrical stimulator is an effective treatment for medically refractory gastroparesis. Laparoscopic subtotal gastrectomy should also be considered as one of the primary surgical treatments for gastroparesis given the significantly higher rate of symptomatic improvement with acceptable morbidity and comparable mortality. Furthermore, the gastric stimulator patients who have no improvement of symptoms can be successfully treated by laparoscopic subtotal gastrectomy.
authors: Department of Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA 90033, USA. joerg.zehetner@surgery.usc.edu
authors: Joerg
authors: J
authors: Zehetner
authors: Farrokh
authors: F
authors: Ravari
authors: Shahin
authors: S
authors: Ayazi
authors: Afshin
authors: A
authors: Skibba
authors: Ali
authors: A
authors: Darehzereshki
authors: Diana
authors: D
authors: Pelipad
authors: Rodney J
authors: RJ
authors: Mason
authors: Namir
authors: N
authors: Katkhouda
authors: John C
authors: JC
authors: Lipham
mesh_terms: D000328:Adult; D004599:Electric Stimulation Therapy / Q000379:methods* / Q000401:mortality; D005260:Female; D005743:Gastrectomy / Q000379:methods* / Q000401:mortality; D018589:Gastroparesis / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D010535:Laparoscopy / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D016896:Treatment Outcome