Management of refractory gastroparesis is challenging after diet, prokinetics, and long-term nutritional support have failed. In this review, the efficacy and safety of surgical interventions (sleeve gastrectomy and Roux-en-Y gastric bypass surgery) are evaluated systematically in patients with refractory gastroparesis. Outcome of interest was symptom improvement and gastric emptying. Nineteen studies with 222 refractory gastroparesis patients (147 Roux-en-Y gastric bypass, 39 sleeve gastrectomy, and 36 subtotal gastrectomy) were included. All studies reported symptom improvement postoperatively, particularly vomiting and nausea. Gastric emptying improved postoperatively in 45% up to 67% for sleeve gastrectomy and 87% for Roux-en-Y gastric bypass. The findings of our systematic review suggest that sleeve gastrectomy and Roux-en-Y gastric bypass surgery improve symptoms and gastric emptying in patients with refractory gastroparesis. Surgery may be effective as treatment for a small group of patients when all other therapies have failed.The resolution of the world epidemic of morbid obesity is debatable, and it is still impossible to find a drug in laboratories. Consequently, bariatric surgeries are the most successful method for EWL as well as managing comorbid metabolic diseases nowadays.

Basically, surgical operations for morbid obesity include complete restriction of food such as gastric band as well as sleeve gastrectomy, in addition to a combination of restriction and reducing intestinal absorption restrictive/mal-malabsorptive RYGBP and BPD-DS. The most effective durable malabsorptive operations carry the nutritional complications that may make patients suffer for life. Because of the feasibility of restrictive gastric operations as the gastric sleeve is done in a wide range worldwide. A lesson learned from redo surgery changed the pendulum to swing away from pure restriction toward malabsorptive procedures.

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Mishita
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Journal of Heart and Cardiovascular Research