Patient Question from Austin, TX
Courtney from Austin sent us this question:
“I suffer from diabetic gastroparesis, a hiatal hernia, and diverticulosis. In 2017, I had bowel obstruction surgery repaired with mesh. I wish I were local to Houston to be your patient, as local doctors only prescribe medicine that is not helping. I want to lose weight but struggle with digestive, food, and medication sensitivities. Could you refer me to a surgeon in Austin, TX, who shares your mindset? I’m interested in Gastric Sleeve surgery for weight loss and relief from gastroparesis and diabetes. Thank you”.
Our Expert Response
Dear Courtney,
The surgical treatment of medically refractory diabetic gastroparesis is not well established. Indeed, there is no agreed upon guideline for treatment of severe gastroparesis in general, and diabetic gastroparesis in particular.
Most bariatric surgeons recommend gastric bypass surgery to treat gastroparesis, especially if you are overweight and diabetic. Furthermore, gastric bypass surgery is often preferred over gastric sleeve surgery for GERD treatment in the setting of hiatal hernia and obesity.
However, our approach to gastroparesis and GERD management, in the setting of diabetes and obesity, is radically different. I am not aware of any surgeon in Austin or anywhere else in Texas who has adopted our treatment algorithm for diabetic gastroparesis.
Why We Avoid Traditional Bariatric Surgeries
The procedure I offer for medically refractory gastroparesis is neither sleeve gastrectomy nor gastric bypass. Both gastric sleeve and gastric bypass surgeries do not improve gastric emptying and do not alleviate nausea, bloating, pain, and vomiting.
It is very important for you to understand that gastric sleeve surgery, as it is performed by most bariatric surgeons, entails the resection of part of the antrum. The antrum is the lower one-third of the stomach and is considered the gastric pump. It is made of thick muscular layer that propels food down into the intestines.
The stomach pump (gastric antrum) must be preserved in any gastroparesis surgery to promote gastric emptying. Therefore, I caution you against undergoing traditional sleeve gastrectomy for medically refractory gastroparesis.
Our Recommended Approach: Antrum-Preserving Longitudinal Gastrectomy
Instead, I recommend an antrum-preserving longitudinal stomach resection. This procedure, unlike a sleeve gastrectomy, preserves the stomach pump (antrum) to promote gastric emptying.
The hiatal hernia is concomitantly repaired with antrum-preserving longitudinal gastrectomy to reliably stop acid reflux. I have been using this approach since 2015 at both Houston Heartburn Reflux Center and Houston Weight Loss Surgery Center with excellent results.
This approach, however, is still considered experimental. However, it is safe and much more reliable than any other available solution for medically refractory gastroparesis.
Struggling with Symptoms?
If you struggle with daily nausea and vomiting after eating, give us a call at 832-945-8717.