Papasavas Pavlos K, Ng Janet S, Stone Andrea M, Ajayi Olayemi A, Muddasani Kiranmayi P, Tishler Darren S
Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
Division of Metabolic and Bariatric Surgery, Hartford Hospital, Hartford, Connecticut.
Surg Obes Relat Dis. 2014 Sep-Oct;10(5):795-9. doi: 10.1016/j.soard.2014.01.013. Epub 2014 Jan 29.
Few treatments for idiopathic and diabetic gastroparesis exist beyond symptom management, and no study has described gastric surgery for gastroparesis in obese and morbidly obese patients. The objective of this study was to describe treatment of recalcitrant gastroparesis in obese adults with Roux-en-Y gastric bypass (RYGB) surgery.
A retrospective review was conducted of adult patients who underwent laparoscopic RYGB. Clinical data pre- and postsurgery and at a follow-up of up to 2 years were reviewed. Total symptom scores for gastroparetic symptom severity and frequency were compared presurgery and at follow-up using paired t tests.
Seven obese and morbidly obese patients (body mass index [BMI] = 39.5, range = 33-54; 6 women) with idiopathic or diabetic gastroparesis reported marked symptom improvement, and total symptom scores significantly decreased after RYGB. All 4 patients who were taking prokinetics preoperatively no longer required their medication after surgery. Three patients required prolonged treatment with antinausea medications in the postoperative period. Mean BMI change was 9.1 units and mean percent excess weight lost was 71.6 lbs. No perioperative complications were experienced. Two required readmissions due to various concerns (dysphagia, nausea, anastomotic ulcer).
In our cohort, no patients required the use of prokinetics after surgery and everyone experienced significant improvement in symptoms. Importantly, we found that RYGB is a safe surgical treatment for gastroparesis in obese patients. Our results indicate that gastroparesis, primarily believed to result in being underweight, can present in morbid obesity and can be markedly improved with RYGB.
除了症状管理外，针对特发性和糖尿病性胃轻瘫几乎没有其他治疗方法，并且尚无研究描述肥胖和病态肥胖患者胃轻瘫的胃部手术治疗。本研究的目的是描述肥胖成年人 Roux-en-Y 胃旁路术（RYGB）治疗难治性胃轻瘫的情况。
对接受腹腔镜 RYGB 的成年患者进行回顾性研究。回顾了手术前后及长达 2 年随访的临床数据。使用配对 t 检验比较术前和随访时胃轻瘫症状严重程度和频率的总症状评分。
7 例患有特发性或糖尿病性胃轻瘫的肥胖和病态肥胖患者（体重指数[BMI]=39.5，范围=33 - 54；6 名女性）报告症状明显改善，RYGB 术后总症状评分显著降低。术前服用促动力药的 4 例患者术后均不再需要用药。3 例患者术后需要长期使用抗恶心药物治疗。平均 BMI 变化为 9.1 个单位，平均多余体重减轻 71.6 磅。未发生围手术期并发症。2 例因各种问题（吞咽困难、恶心、吻合口溃疡）需要再次入院。
在我们的队列中，术后没有患者需要使用促动力药，并且每个人的症状都有显著改善。重要的是，我们发现 RYGB 是肥胖患者胃轻瘫的一种安全手术治疗方法。我们的结果表明，胃轻瘫主要被认为会导致体重过轻，在病态肥胖中也可能出现，并且 RYGB 可以使其明显改善。
