Pradhan Grishma, Robinson Tyler D, Northrup Casey, Ata Ashar, Singh Tejinder P, Zaman Jessica A
Department of General Surgery, Albany Medical Center, Sixth Floor, 50 New Scotland Avenue, Albany, NY, 12208, USA.
Surg Endosc. 2025 Aug 29. doi: 10.1007/s00464-025-12066-9.
Botulinum toxin injection of the pylorus (BP) improves gastric transit after esophagectomy (Saeed et al. in Surg Endosc 38(10):6046-52, 2024). At our institution, BP has been used as an adjunct to sleeve gastrectomy (SG) to reduce post-operative nausea and vomiting (PONV). We studied the safety and efficacy of this practice.
A prospective, double-blinded randomized controlled trial of SG was performed with and without intraoperative BP at a large tertiary care medical center over a 3-year period was done. The primary outcome measured was safety of intraoperative BP during SG and followed by efficacy in treating PONV.
We performed a prospective RCT on 57 SGs performed from 2019 to 2022. There were no differences in operative time (106.8 min BP vs. 106.4 min placebo, p = 0.94) and length of stay (1.68 days BP vs. 1.48 days placebo, p = 0.40). There were no intraoperative complications and one 30-day readmission for chest pain and dehydration in the placebo group. Utilization of outpatient hydration was equivalent (7.14% BP vs 6.90% placebo, p > 0.99). Anti-emetic usage (53.57% BP and 58.62% placebo, p = 0.70) and self-reported nausea (46.43% BP and 51.72% cohort, p = 0.79) were comparable.
Intraoperative BP during SG is safe but does not improve peri-operative outcomes or patient-reported PONV when compared to standard ERAS measures. We were limited by reduction in elective bariatric case volume during the pandemic. Future study administering botulinum toxin preoperatively during endoscopy may be more successful.
幽门注射肉毒杆菌毒素（BP）可改善食管切除术后的胃排空（Saeed等人，《外科内镜杂志》38(10):6046 - 52, 2024）。在我们机构，BP已被用作袖状胃切除术（SG）的辅助手段，以减少术后恶心和呕吐（PONV）。我们研究了这种做法的安全性和有效性。
在一家大型三级医疗中心进行了一项为期3年的前瞻性、双盲随机对照试验，比较了SG术中使用和不使用BP的情况。主要测量结果是SG术中BP的安全性，其次是治疗PONV的有效性。
我们对2019年至2022年进行的57例SG进行了前瞻性随机对照试验。手术时间（BP组106.8分钟 vs. 安慰剂组106.4分钟，p = 0.94）和住院时间（BP组1.68天 vs. 安慰剂组1.48天，p = 0.40）没有差异。术中无并发症，安慰剂组有1例因胸痛和脱水在30天内再次入院。门诊补液的使用率相当（BP组7.14% vs. 安慰剂组6.90%，p > 0.99）。止吐药的使用情况（BP组53.57%和安慰剂组58.62%，p = 0.70）和自我报告的恶心情况（BP组46.43%和队列组51.72%，p = 0.79）相当。
与标准的加速康复外科措施相比，SG术中使用BP是安全的，但并不能改善围手术期结局或患者报告的PONV。我们受到疫情期间择期减肥手术病例数量减少的限制。未来在内镜检查期间术前给予肉毒杆菌毒素的研究可能会更成功。
