Gastroparesis following Nissen Fundoplication Surgery

Gastroparesis following Nissen Fundoplication Surgery

Nelson from Houston emailed us this question:

“I have been diagnosed with gastroparesis years after Nissen fundoplication surgery for GERD. Would any of these surgical procedures help me at this point. I barely leave the house for fear of needing a bathroom in an emergency”.

Dear Nelson,

I am not sure which surgical procedure you are referring to for treatment of gastroparesis. However, a number of surgical options like pyloroplasty and a tailored longitudinal gastrectomy along the greater curvature may be offered in the setting of Nissen fundoplication. Pyloroplasty is minimally invasive and can be performed endoscopically nowadays. Per-oral endoscopic pyloromyotomy has been described in a number of studies for treatment of gastroparesis. The procedure is safe, but its efficacy is limited. Gastroparesis is complex gastric motility disorder and gastric drainage procedure like pyloroplasty and gastro-jejunostomy have a low success rate. A tailored longitudinal gastrectomy that preserves the gastric antrum (gastric pump) seems to promote gastric emptying and reverse gastroparesis symptoms even in the setting of Nissen or Toupet fundoplication. I have tried this approach on a limited number of patients with severe gastroparesis refractory to medical treatment. Surgery outcome was great with normalization of gastric emptying and complete resolution of nausea, bloating, vomiting and abdominal pain.

Gastroparesis developing years after Nissen fundoplication is most likely not related to fundoplication surgery itself. Diabetes, viral infections, autoimmune diseases… may cause gastroparesis. the majority of cases are however idiopathic. Thorough evaluation by a Houston acid reflux specialist who has special interest in gastroparesis is recommended prior to any surgical intervention in this particular case.