M. G. Hughes1, B. Cacchione1, E. Miller2, L. McElmurray2, R. Allen3, A. Stocker2, T. L. Abell2 1University Of Louisville,Surgery,Louisville, KY, USA 2University Of Louisville,Medicine,Louisville, KY, USA 3KentuckyOne Health,Anesthesiology,Louisville, KY, USA
Introduction: We have previously shown that implant hospital length of stay (LOS) for gastric electrical stimulation (GES) implantation varies with type of surgery and peri-operative care (JSLS. 2005; 9:305-310). We now compare outcomes for GES via mini-laparotomy with adjuctive care (MLAC) vs. laparoscopy alone (LAPA) to measure equivalency.
Methods: Patients were evaluated with baseline solid gastric emptying tests (GET) and underwent pre-operative temporary endoscopic GES (Am Surg 79(5):457-64) in both groups prior to permanent implant. Patients with MLAC had pre-operative transvere abdominus plane (TAP) block with bupivacaine liposome of the lower abdomen to cover the area of generator placement. Laparotomy was typically performed through a 2.5 – 3.0 cm midline incision above the area covered by TAP block. Retraction was provided by disposable wound protector (Alexis Wound Protractor/Retractor, Applied Medical, Racho Santa Margarita, CA) that typically lengthened the wound to approximately 4 – 5 cm. Pain control system was placed in the pre-peritoneal abdominal wall to both sides of midline wound (On-Q Pain Buster Post-Op Pain Relief System, I-Flow LLC, Irvine, CA). This delivered 750 cc of 0.2% ropivacaine at 10 cc/hour (approximately 3 days) and then was removed and discarded by patients after discharge. Patients with LAPA were treated with a similar post-operative oral and intravenous analgesia regimen but no adjunctive care (TAP or pain control system). Health related quality of life (HRQOL) was measured by IDIOMS (NGM 2005; 17: 35-43) at baseline. Follow up GI symptoms were recorded at last follow up. Results were reported as median or mean ± standard deviation and were compared by Wilcoxon rank-sum test or students t-test, respectively.
Results: 39 patients (87% female, mean age 43 years) with the symptoms of gastroparesis underwent MLAC and were compared with 36 patients (92% f, mean 42 years) who had LAPA. We aimed to compare the equivalency of MLAC to LAPA approach in terms of baseline and outcome measures. Baseline GI symptom scores (for nausea, vomiting, anorexia/early satiety, bloating/distention, and abdominal pain), solid GET and HRQOL were similar between the 2 groups (p>0.05). Median implant length of stay was significantly shorter in MLAC (2.0 days) than LAPA (3.0 days; p=0.02). Follow up GI symptoms (were equivalent in the two groups (p>0.05).
Conclusion: For implantation of gastric electrical stimulators in this group of patients with gastroparesis, mini-laparotomy is as effective in improving symptoms as laparoscopic implantation and can result in shorter lengths of stay when coupled with adjunctive measures to limit incision size and relieve pain.