OF GASTRIC EMPTYING AFTER GASTRIC PULL UP
Ibrahim Gala Khalifa, MD, Ahmed Farag,
MD, and Tarek Said, MD
of Surgery, Faculty of Medicine, Cairo University, Cairo, Egypt.
Egyptian Journal of Surgery, Vol
(18), No (2), June 1999: 165-170
Gastroparesis is a common sequel after
gastric pull up. It was advised to perform a gastric drainage procedure
routinely to avoid the development of gastric retention secondary to gastroparesis.
However the results were inconsistent and the side effects were compelling.
In order to avoid such mishap, a conservative approach was tried in thirty
patients with gastric pull up sparing them any form of gastric drainage
procedures. Prokinetic therapy and diet control were used to tide
the patients over, until gastroparesis improves spontaneously as expected
within few weeks postoperatively. Continuous clinical monitoring as well
as gastroscintingraphy (done 3 and 8 weeks postoperative) were used to
evaluate the progress of gastric emptying. It was found that 96.7% of patients
were symptom free and had adequate gastric emptying within two months postoperative,
while 3.3% of patients had persistent vomiting and significant delay in
gastric emptying for three months postoperative that was relieved by endoscopic
balloon dilatation of the pylorus In conclusion, gastroparesis can be treated
conservatively as it is a reversible disorder in the great majority of
cases. Gastric drainage is usually associated with notorious side effects
and is better to be reserved for the minority of patients in whom gastroparesis
will not improve under conservative treatment.
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