Modified laparoscopic pyloroplasty added to laparoscopic splenectomy and azygoportal disconnection prevents postoperative gastroparesis

Objective To evaluate the feasibility and safety of modified laparoscopic pyloroplasty (LP) during laparoscopic splenectomy and azygoportal disconnection (LSD) for the prevention of postoperative gastroparesis. Methods A total of 31 cirrhotic patients with bleeding portal hypertension admitted to our department between Jan 2015 and Aug 2015 were retrospectively reviewed. Patients were divided into LP group (n=14) and non-LP group (n=17). Results One month postoperatively, the incidence of bloating was significantly lower in the LP group than in the non-LP group [21% vs. 88%, P<0.05]. Three months postoperatively, the LP group had significantly lower incidences of nausea (0 vs. 35%, P<0.05) and bloating (14 % vs. 76%, P<0.05) than the non-LP group. The incidence of gastric retention confirmed by electronic gastroscopy at 3 and 6 months postoperatively in the LP group was significantly lower than that in the non-LP group (14% vs. 94%, P<0.01; 14% vs. 88%, P<0.01, respectively). Conclusion It is safe, feasible and with good therapeutic effect for modified laparoscopic pyloroplasty during laparoscopic splenectomy and azygoportal disconnection for the prevention of postoperative gastroparesis. Key words: Hypertension, portal; Gastroparesis; Pylorus; Laparoscopes