Outcomes of Hiatal Hernia Repair and Fundoplication with or without Pyloromyotomy or Pyloroplasty in patients with GERD and Gastroparesis.
Romulo Fajardo, Charles Bakhos, Roman Petrov, Henry Parkman, Zubair Malik, Abbas Abbas
Temple University Hospital, Philadelphia, PA, USA
OBJECTIVE: To investigate the outcomes of hiatal hernia repair (HHR) and fundoplication with or without pyloromyotomy or pyloroplasty in patients with gastroesophageal reflux disease (GERD) and gastroparesis.
METHODS: Retrospective review of all patients with GERD and gastroparesis as defined by greater than 60% or 10% gastric retention of solids at 2 hours and 4 hours respectively, who underwent minimally invasive anti-reflux surgery with or without pyloromyotomy or pyloroplasty from August 1, 2016 to September 1, 2019 at a single tertiary referral center.
RESULTS: Thirty-six patients with delayed gastric emptying were identified with a mean 2-hr and 4-hr gastric retention of 63% and 27% respectively. All cases were performed robotically and included Toupet (14), Nissen (21), and 1 partial anterior fundoplication. There was no 90-day mortality and the mean length of stay was 2 ± 1.49 days (range 0-8 days). Median follow up duration was 5 months (10 days to 30 months). Symptomatic improvement was observed in 86% of patients (31/36). Five patients had repeat gastric emptying studies postoperatively, with 2 patients resulting in normalization compared preoperatively. Symptomatic improvement was observed in 87.5% (14/16) of patients who received either a pyloroplasty or pyloromyotomy as opposed to 80% (16/20) who received neither.
CONCLUSIONS: Minimally invasive HHR and fundoplication with or without pyloromyotomy or pyloroplasty is safe and effective in patients with GERD and gastroparesis. A randomized control trial with post-operative objective measurement of gastric emptying and reflux is necessary to confirm the benefits of surgery in this patient population.
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