Haslam Miranda, Parkman Henry P, Petrov Roman V
Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Department of Medicine, Section of Gastroenterology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Dig Med Res. 2020 Dec;3. doi: 10.21037/dmr-20-70.
Gastroparesis is a chronic gastric motility disorder characterized by delayed gastric emptying and a multitude of troublesome symptoms, including chronic nausea, vomiting, abdominal pain, malnutrition, and dehydration. Whereas initial management of the gastroparesis is conservative, patient with refractory gastroparesis may benefit from surgical therapy, including gastric electric stimulator (GES) device implantation. Twiddler's syndrome is a challenging condition well described in the cardiac literature that is characterized by the instability, displacement, leads twisting and resulting malfunction of an implanted device, believed to be due to manipulation (twiddling) by the patient. The condition is not specifically characterized in the GES literature; however, evidence suggest the incidence of the Twiddler's syndrome is reaching up to 9% of the patients with GES. In the current report we present a case of surgical management of the recurrent Twiddler's syndrome in a patient with a GES device with novel non-FDA approved use of the TYRX Absorbable Antibacterial Envelope for the device stabilization. Use of the TYRX enveloped provided additional anchoring points of fixation, resulting in the successful resolution of the device instability and the Twiddler's syndrome with and ongoing follow up of up to 8 months. This report adds to the armamentarium of surgical management of this uncommon and difficult problem.
胃轻瘫是一种慢性胃动力障碍疾病，其特征为胃排空延迟以及诸多令人困扰的症状，包括慢性恶心、呕吐、腹痛、营养不良和脱水。胃轻瘫的初始治疗较为保守，但难治性胃轻瘫患者可能从手术治疗中获益，包括植入胃电刺激器（GES）装置。“扭转综合征”是心脏领域文献中描述的一种棘手病症，其特征为植入装置不稳定、移位、导线扭转并导致装置故障，据信这是患者操作（扭转）所致。这种情况在GES相关文献中并无具体描述；然而，有证据表明“扭转综合征”在GES患者中的发生率高达9%。在本报告中，我们呈现了一例使用新型非FDA批准的TYRX可吸收抗菌包膜稳定装置治疗GES装置复发性“扭转综合征”患者的手术案例。使用TYRX包膜提供了额外的固定锚点，成功解决了装置不稳定问题以及“扭转综合征”，并持续随访长达8个月。本报告为这一罕见且棘手问题的手术治疗增添了方法。
