title: End of the road for a dysfunctional end organ: laparoscopic gastrectomy for refractory gastroparesis.
abstract: BACKGROUND
  Gastroparesis is a functional disorder resulting in debilitating nausea, esophageal reflux, and abdominal pain and is frequently refractory to medical treatment. Therapies such as pyloroplasty and neurostimulators can improve symptoms. When medical and surgical treatments fail, palliative gastrectomy is an option. We examined outcomes after gastrectomy for postoperative, diabetic, and idiopathic gastroparesis.
  
  
  METHODS
  A prospective database was queried for gastrectomies performed for gastroparesis from 1999 to 2013. Primary outcomes were improvements in pre- versus postoperative symptoms at last follow-up, measured on a five-point scale. Secondary outcome was operative morbidity.
  
  
  RESULTS
  Thirty-five patients underwent laparoscopic total or near-total gastrectomies for postoperative (43 %), diabetic (34 %), or idiopathic (23 %) gastroparesis. Antiemetics and prokinetics afforded minimal relief for one third of patients. There were no mortalities. Six patients suffered a leak, all treated with surgical reintervention. With a median follow-up of 6 months, nausea improved or resolved in 69 %. Chronic abdominal pain improved or resolved in 70 %. Belching and bloating resolved for 79 and 89 %, respectively (p < 0.01).
  
  
  CONCLUSIONS
  Regardless of etiology, medically refractory gastroparesis can be a devastating disease. Near-total gastrectomy can ameliorate or relieve nausea, belching, and bloating. Chronic abdominal pain commonly resolved or improved with resection. Despite attendant morbidity, gastrectomy can effectively palliate symptoms of gastroparesis.
authors.affiliation: Providence Cancer Center, Portland, OR, USA, neil03@gmail.com.
authors.forename: Neil H
authors.initials: NH
authors.lastname: Bhayani
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Sharata
authors.forename: Christy M
authors.initials: CM
authors.lastname: Dunst
authors.forename: Ashwin A
authors.initials: AA
authors.lastname: Kurian
authors.forename: Kevin M
authors.initials: KM
authors.lastname: Reavis
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
mesh_terms: D015746:Abdominal Pain / Q000601:surgery; D048909:Diabetes Complications / Q000150:complications / Q000601:surgery*; D004884:Eructation / Q000601:surgery; D005260:Female; D005743:Gastrectomy / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000601:surgery; D018589:Gastroparesis / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000601:surgery; D011183:Postoperative Complications / Q000601:surgery*; D019233:Retreatment; D012720:Severity of Illness Index; D016896:Treatment Outcome