Living with gastroparesis can be debilitating and result in frequent visits to the emergency room for nausea, vomiting and pain. The good news is treatment of gastroparesis has evolved significantly in recent years and our team knows how to get you back to living a full life again.
PYLOROPLASTY PROCEDURE
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What is it?
The pylorus is a muscle that serves as a sphincter at the end of your stomach that releases food into your small intestine after it is digested. When closed, it blocks food from leaving the stomach. With gastroparesis, nerve damage to the pylorus leaves it in the closed position.
How does it work?
The symptoms of gastroparesis are due to the stomach not emptying normally. Pyloroplasty decompresses the stomach into your small intestine (the direction food is supposed to flow) rather than up your esophagus (heartburn) and out your mouth (nausea and vomiting). In this procedure, the pylorus is cut open and then sewn shut in a crosswise fashion so that it remains wide open allowing food to pass through more easily.
What’s involved?
This procedure can typically be performed laparoscopically which involves using a camera through several small incisions. This is an outpatient procedure, it takes about an hour, and you are able to go home the same day.
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What can I expect?
Immediately after the surgery, the pyloric channel will be wide open. However, it will swell and narrow for 1-3 weeks. During this time, you may feel no better than before the surgery and will need to limit your diet to liquids and pureed, soft, and mashed foods.
As you feel better, you can start reintroducing solid food. By 1 month, when you see Dr. Hughes back in the clinic, you should feel most of the impact of the pyloroplasty and start getting an idea of whether the gastric stimulator will be needed.
If you gave up on promethazine and/or ondansetron because they didn’t work, then you should try them again as they may be much more effective with your stomach decompressed.
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What if pyloroplasty does not help me?
For most patients, pyloroplasty is all they need. With the stomach emptying better and no longer under pressure, the nausea typically improves as the Vagus nerve is no longer signaling the brain to make them sick. For reasons that we do not fully understand, a minority of patients have persistent nausea even after the stomach is decompressed with pyloroplasty. We can then place a gastric stimulator to treat the nausea. If you are one of these patients, then the pyloroplasty is still useful, as we likely will not need to turn the gastric stimulator up as high as we would have if you did not have the pyloroplasty.
What about dumping syndrome?
Dumping syndrome has been seen in some patients after pyloroplasty when done for stomach ulcers, not for gastroparesis.
Decades ago, before we had effective antacid medication, surgeons would cut the vagus nerve to shut down acid production and heal ulcers. Knowing that cutting the vagus nerve would result in the pylorus staying shut, surgeons would perform pyloroplasty at the same time. Prior to surgery, these ulcer patients emptied their stomachs normally.
After surgery, they would sometimes empty too fast, particularly with a carbohydrate-rich meal. This would result in diarrhea, lightheadedness, low blood sugar and even passing out. The treatment would be to reduce carbohydrates and increase fat and protein to slow down digestion. As a gastroparesis patient with delayed emptying, we want you to empty more quickly. We also want you to be better able to tolerate a diet balanced with fats and proteins.