Laparoscopic and Endoscopic Pyloroplasty for Gastroparesis Results in Sustained Symptom Improvement

Abstract

Minimally invasive pyloroplasty provides excellent outcomes for patients with gastroparesis and should be considered as a primary treatment along with diet and medications as it is effective and does not eliminate the option for additional surgical options in the future for refractory disease. With technological advancements, a totally endoscopic pyloroplasty may be a less invasive option.

Laparoscopic pyloroplasty is a safe and effective first-line surgical therapy for refractory gastroparesis

“…A singlelayer, hand-sewn Heineke-Mikulicz pyloroplasty was performed laparoscopically as previously reported [6,9]. Briefly, the pylorus is mobilized to facilitate a tension-free closure.…”

“…Feeding jejunostomy and decompressive gastrostomy tubes are also used in select patients. Surgical strategies are often region specific, and all have been shown to be effective in certain subsets of patients [6][7][8]. However, there is no consensus as to which strategy or combination of surgeries is best for treatment of gastroparesis.…”

Understanding the Differences Between Gastroparesis and Gastroparesis-Like Syndrome: Filling a GaPing Hole?

“…Several techniques that have been employed to decrease pylorus resistance have had varying results in symptom improvement and GE. In a retrospective analysis of prospectively collected data, pyloroplasty alone in GP patients was associated with overall improvement in symptoms and improved GE in 83% of patients surveyed [4]. Yet, other studies have described limited success rates, reporting only up to 30% of subjects with normalization of (GE) and some improvement in symptoms following pyloroplasty without gastric stimulator placement.…”

Bioengineered Human Pyloric Sphincters Using Autologous Smooth Muscle and Neural Progenitor Cells

“…5 Patients with gastroparesis caused by damage to the vagus nerve may receive a pyloroplasty to allow for increased passage of food through the pyloric sphincter. 6,7 The effectiveness of pyloroplasty is similar to the short-term results after administration of botulinum toxin and the long-term effects are unclear. 7 Importantly, surgical interventions in patients with gastroparesis have a high risk of complications.…”

“…6,7 The effectiveness of pyloroplasty is similar to the short-term results after administration of botulinum toxin and the long-term effects are unclear. 7 Importantly, surgical interventions in patients with gastroparesis have a high risk of complications. 8 These studies provide hope for the treatment of gastroparesis by targeting pyloric function, however, the obvious ineffectiveness of approaches that provides only transient relief indicates the need for strategies that provide sustained modulation of pyloric sphincter function.…”