SAFETY AND LONG-TERM DURABILITY OF COMPLETION GASTRECTOMY IN 81 PATIENTS WITH POSTSURGICAL GASTROPARESIS SYNDROME

Postsurgical gastroparesis syndrome (PGS) is characterized by postciba l nausea and vomiting and is associated with functional gastric dysmot ility. Patients frequently present with marked weight loss and malnutr ition requiring hospitalization and prolonged parenteral nutrition. Ty pically, these patients fail to respond to prokinetic agents. Gastric reoperations are frequent and usually unsuccessful. Near-completion ga strectomy (NCG) has proved useful in small series of patients, but lon g-term follow-up has been lacking. The purpose of this study is to ass ess the safety and durability of NCG in a large group of patients with PGS. Eighty-one patients with documented PGS who failed to respond to prokinetic drug therapy were treated with NCG over an Ii-year period. NCG was standardized with a 55-cm Roux-en-Y reconstruction. Patients were evaluated by a retrospective chart review and a prospective phone interview that compared pre- and postoperative health status based on a standardized severity of symptoms score. There were no operative de aths or complications related to the anastomosis. Average patient foll ow-up was 56.1 months (range, 2-142 months). Fifteen patients died of unrelated causes, and 14 patients were lost to follow-up. The remainin g 52 patients showed a significant overall decrease in severity of sym ptoms score largely due to reduction in gastrointestinal symptoms and to a smaller but significant reduction in systemic symptoms. Nearly 80 per cent of patients reported long-term relief of symptoms. NCG is th e procedure of choice for carefully selected patients with documented. Low morbidity and durable results can be anticipated in the majority of patients.