Skip to main content

Advertisement

SpringerLink
Log in

Post-surgical and obstructive gastroparesis

  • Published:
Current Gastroenterology Reports Aims and scope Submit manuscript

Abstract

Post-surgical gastroparesis (PSG) is recognized as a consequence of vagal nerve injury following upper abdominal surgery. It has been well documented following vagotomy for peptic ulcer surgery. With the increasing role of surgical treatment in the management of GERD and morbid obesity, PSG is now being diagnosed after fundoplication and bariatric surgery. PSG has also been reported after heart and lung transplantation, possibly due to opportunistic viral infection or motor-inhibitory effects of the immunosuppressive drugs, in addition to vagal nerve injury. Initial postoperative management of PSG should be conservative as many symptoms following abdominal surgery resolve with time. This occurs possibly because the enteric nervous system is able to adapt to the loss of vagal input or vagal reinnervation occurs. Persistent symptoms are difficult to manage and require a multidisciplinary team approach. Gastric electrical stimulation has shown promise in small series.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Soykan I, Sivri B, Sarosiek I, et al.: Demography, clinical characteristics, psychological profiles, treatment and long-term follow-up of patients with gastroparesis. Dig Dis Sci 1998, 43:2398–2404.

    Article  PubMed  CAS  Google Scholar 

  2. Fich A, Neri M, Camilleri M, et al.: Stasis syndromes following gastric surgery: clinical and motility features of 60 symptomatic patients J Clin Gastroenterol 1990 12:505–512.

    Article  PubMed  CAS  Google Scholar 

  3. Eagon JC, Miedema BW, Kelly KA: Postgastrectomy syndromes. Surg Clin North Am 1992, 72:445–465

    PubMed  CAS  Google Scholar 

  4. Nakamura K, Takahashi T, Taniuchi M, et al.: Nicotinic receptor mediates nitric oxide synthase expression in the rat gastric myenteric plexus. J Clin Invest 1998, 101:1479–1489.

    PubMed  CAS  Google Scholar 

  5. Schirmer BD: Current status of proximal gastric vagotomy. Ann Surg 1989, 209:131–148.

    Article  PubMed  CAS  Google Scholar 

  6. Koo J, Lam SK, Chan P, et al.: Proximal gastric vagotomy, truncal vagotomy with drainage, and truncal vagotomy with antrectomy for chronic duodenal ulcer. A prospective, randomized controlled trial. Ann Surg 1983, 197:265–271

    Article  PubMed  CAS  Google Scholar 

  7. Mathias JR, Fernandez A, Sninsky CA, et al.: Nausea, vomiting, and abdominal pain after Roux-en-Y anastomosis: motility of the jejunal limb. Gastroenterology 1985, 88:101–107.

    PubMed  CAS  Google Scholar 

  8. van der Mijle HC, Beekhuis H, Bleichrodt RP, Kleibeuker JH: Transit disorders of the gastric remnant and Roux limb after Roux-en-Y gastrojejunostomy: relation to symptomatology and vagotomy. Br J Surg 1993, 80:60–654.

    Article  PubMed  Google Scholar 

  9. Debas HT, Orloff SL: Surgery for peptic ulcer disease. In Textbook of Gastroenterology, vol. 1. Edited by Yamada T, Alpers DH, Owyang C, et al.: Philadelphia: Lippincott; 1991:1379–1398.

    Google Scholar 

  10. Frantzides CT, Carlson MA, Zografakis JG, et al.: Postoperative gastrointestinal complaints after laparoscopic Nissen fundoplication. JSLS 2006, 10:39–42.

    PubMed  Google Scholar 

  11. Ukleja A, Woodward TA, Achem SR: Vagus nerve injury with severe diarrhea after laparoscopic antireflux surgery. Dig Dis Sci 2002, 47:1590–1593.

    Article  PubMed  Google Scholar 

  12. Kozarek RA, Low DE, Raltz SL: Complications associated with laparoscopic anti-reflux surgery: One multispecialty clinic’s experience. Gastrointest Endosc 1997, 46:527–531.

    Article  PubMed  CAS  Google Scholar 

  13. Kozarek RA, Low DE, Raltz SL: Laparoscopic anti-reflux surgery. Early community experience with discordant results when querying gastroenterologists or surgeons [abstract], Gastrointest Endosc 1996, 43:316.

    Google Scholar 

  14. Lundell LR, Myers JC, Jamieson GG: Delayed gastric emptying and its relationship to symptoms of “gas bloat” after antireflux surgery. Eur J Surg 1994, 160:161–166.

    PubMed  CAS  Google Scholar 

  15. Bais JE, Samsom, M, Boudesteijn, EA, et al.: Impact of delayed gastric emptying on the outcome of antireflux surgery. Ann Surg 2001, 234:139–146.

    Article  PubMed  CAS  Google Scholar 

  16. Farrell TM, Richardson WS, Halkar R, et al.: Nissen fundoplication improves gastric motility in patients with delayed gastric emptying. Surg Endosc 2001, 15:271–274.

    Article  PubMed  CAS  Google Scholar 

  17. Bustorff-Silva J, Perez CA, Fonkalsrud EW, et al.: Gastric emptying procedures decrease the risk of postoperative recurrent reflux in children with delayed gastric emptying. J Pediatr Surg 1999, 34:79–82.

    Article  PubMed  CAS  Google Scholar 

  18. Maxson RT, Harp S, Jackson RJ, et al.: Delayed gastric emptying in neurologically impaired children with gastroesophageal reflux: the role of pyloroplasty. J Pediatr Surg 1994, 29:726–729.

    Article  PubMed  CAS  Google Scholar 

  19. Dong KE, Xiao Jiong YU, Bo LI, et al.: Advances in mechanisms of postsurgical gastroparesis syndrome and its diagnosis and treatment. Chin J Dig Dis 2006, 7:76–82.

    Article  PubMed  Google Scholar 

  20. Malfertheiner P, Sarr MG, DiMagno EP: Role of the pancreas in the control of interdigestive gastrointestinal motility. Gastroenterology 1989, 96:200–205.

    PubMed  CAS  Google Scholar 

  21. Tanaka M, Sarr MG: Role of the duodenum in the control of canine gastrointestinal motility. Gastroenterology 1998, 94:622–629.

    Google Scholar 

  22. Berkowitz N, Schulman LL, McGregor C, Markowitz D: Gastroparesis after lung transplant—potential role in postoperative respiratory complications. Chest 1995, 108:1602–1607.

    PubMed  CAS  Google Scholar 

  23. Abell TL, Minocha A: Gastrointestinal complications of bariatric surgery: diagnosis and therapy. Am J Med Sci 2006, 331:214–218.

    Article  PubMed  Google Scholar 

  24. Yusuf TE, Brugge WR: Endoscopic therapy of benign pyloric stenosis and gastric outlet obstruction Curr Opin Gastroenterol 2006, 22:570–573

    Article  PubMed  Google Scholar 

  25. Lee HR, Lennon VA, Camilleri M, Prather CM: Paraneoplastic gastrointestinal motor dysfunction: clinical and laboratory characteristics. Am J Gastroenterol 2001, 96:373–379.

    Article  PubMed  CAS  Google Scholar 

  26. Kalbasi H, Hudson FR, Herring A: Gastric emptying following vagotomy and antrectomy and proximal gastric vagotomy. Gut 1975, 16:509–513.

    PubMed  CAS  Google Scholar 

  27. Cowley DJ, Vernon P, Jones T, et al.: Gastric emptying of solid meals after truncal vagotomy and pyloroplasty in human subjects. Gut 1972, 13:176–181.

    PubMed  CAS  Google Scholar 

  28. Howlett PJ, Sheiner HJ, Barber DC, et al.: Gastric emptying in control subjects and patients with duodenal ulcer before and after vagotomy. Gut 1976, 17:542–550.

    PubMed  CAS  Google Scholar 

  29. Phillips RJ, Baronowsky EA, Powley TL: Long-term regeneration of abdominal vagus: efferents fail while afferents succeed. J Comp Neurol 2003, 455:222–237.

    Article  PubMed  Google Scholar 

  30. Patterson DJ: Prokinetic agents in postgastrectomy patients. Gastroenterol Clin North Am 1994, 23:313–325.

    PubMed  CAS  Google Scholar 

  31. Petrakis J, Vassilakis JS, Karkavitsas N, et al.: Enhancement of gastric emptying of solids by erythromycin in patients with Roux-en-Y gastrojejunostomy. Arch Surg 1998, 133:709–714.

    Article  PubMed  CAS  Google Scholar 

  32. Gujar P, Remde A, DeAntonio JR: Roux stasis syndrome: clinical improvement with tegaserod. J Clin Gastroenterol 2005, 39:550–551.

    Article  PubMed  Google Scholar 

  33. Jones MP, Maganti K: A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 2003, 98:2122–2129.

    Article  PubMed  Google Scholar 

  34. Eckhauser FE, Conrad M, Knol JA, et al.: Safety and long-term durability of completion gastrectomy in 81 patients with postsurgical gastroparesis syndrome. Am Surg 1998, 64:711–716.

    PubMed  CAS  Google Scholar 

  35. Forstner-Barthell AW, Murr MM, Nitecki S, et al.: Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg 1999, 3:15–21.

    Article  PubMed  CAS  Google Scholar 

  36. Karlstrom LH, Soper NJ, Kelly KA, Phillips SF: Ectopic jejunal pacemakers and enterogastric reflux after Roux gastrectomy: effect of intestinal pacing. Surgery 1989, 106:486–495.

    PubMed  CAS  Google Scholar 

  37. Oubre B, Luo J, Al-Juburi A, et al.: Pilot study on gastric electrical stimulation on surgery-associated gastroparesis: long-term outcome. South Med J 2005, 98:693–697.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Texas Medical Branch, 4.106 McCullough Building, 301 University Boulevard, Galveston, TX, 77555-0764, USA

    P. Jay Pasricha MD

Authors
  1. Mehnaz A. Shafi MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Jay Pasricha MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to P. Jay Pasricha MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Shafi, M.A., Pasricha, P.J. Post-surgical and obstructive gastroparesis. Curr Gastroenterol Rep 9, 280–285 (2007). https://doi.org/10.1007/s11894-007-0031-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11894-007-0031-2

Keywords

Search

Navigation