How is postoperative gastroparesis treated?
Postoperative gastroparesis typically occurs in patients who undergo surgery for GOO. Evaluation should begin with esophagogastroduodenoscopy, upper GI series with small bowel follow-through, and gastric emptying scan. Once mechanical obstruction has been ruled out, medical treatment is successful in most cases. Prokinetic agents such as erythromycin and metoclopramide may be helpful. The indications for reoperation are:
- Early marginal ulcers refractory to medical management
- Anatomic abnormalities of the gastric outlet
- Recurrent bezoar associated with weight loss
Intractable gastroparesis following vagotomy and drainage may be treated with subtotal gastrectomy and Roux-en-Y reconstruction. If the gastric remnant is large, a Billroth II reconstruction may be preferable to Roux-en-Y reconstruction because the latter option may be associated with persistent gastric emptying problems. Gastroparesis may be managed with preoperative nasogastric tube decompression for the severely dilated stomach.