Name of the Procedure:

Laparoscopy, surgical; implantation or replacement of gastric neurostimulator electrodes, antrum

• Common names: Gastric neurostimulator implantation, Gastric pacemaker surgery
• Technical terms: Gastric electrical stimulation (GES), Laparoscopic implantation of gastric neurostimulator

Summary

In this minimally invasive surgical procedure, electrodes are implanted in the stomach's antrum area to help manage symptoms of gastroparesis. The procedure is done using laparoscopy, which involves small incisions and the use of a camera to guide the surgery.

Purpose

Gastroparesis is a condition where the stomach cannot empty itself of food in a normal fashion. The goal of the procedure is to reduce symptoms such as nausea, vomiting, and bloating by stimulating the stomach muscles with electrical pulses.

Indications

• Chronic nausea and vomiting
• Diagnosed gastroparesis that is not adequately managed with medications or dietary changes
• Patients with diabetes-induced gastroparesis or idiopathic gastroparesis
• Failure to respond to conservative treatments

Preparation

• Fasting from midnight before the surgery
• Discontinuation of certain medications as advised by the doctor
• Blood tests, an EKG, and possibly imaging studies for assessment

Procedure Description

1. Anesthesia: The procedure is performed under general anesthesia.
2. Incisions: Small incisions are made in the abdomen to introduce laparoscopic instruments and a camera.
3. Inserting the Electrodes: Electrodes are carefully placed in the muscle layer of the stomach.
4. Connecting the Device: The electrodes are connected to a neurostimulator, which is often implanted under the skin in the abdominal area.
5. Testing: The system is tested to ensure proper function.
6. Closing Incisions: The small incisions are closed with sutures or surgical glue.

Duration

Typically, the procedure takes about 2 to 3 hours.

Setting

Performed in a hospital operating room or surgical center equipped for laparoscopic surgery.

Personnel

• Surgeons specialized in gastrointestinal surgery
• Anesthesiologists
• Surgical nurses
• Possibly a gastroenterologist

Risks and Complications

• Infection
• Bleeding
• Displacement or malfunction of the electrodes or neurostimulator
• Anesthesia-related complications
• Damage to surrounding organs or tissues

Benefits

• Significant reduction in the frequency and severity of nausea and vomiting
• Improvement in stomach emptying rate
• Enhanced overall quality of life
• Benefits can often be realized a few weeks after the procedure

Recovery

• Immediate post-operative monitoring for a few hours
• Hospital stay of usually one to two days
• Recommendations for light activity for a few weeks and avoiding heavy lifting
• Follow-up appointments to check the device and adjust settings if necessary

Alternatives

• Dietary modifications and nutritional support
• Medications to increase stomach motility or reduce symptoms
• Endoscopic treatments
• Total or partial gastrectomy (more invasive surgical option)

Patient Experience

• Expect some discomfort or pain at the incision sites post-surgery
• Pain can be managed with prescribed medications
• Most patients can resume normal activities within a few weeks, but full recovery might take longer
• Regular follow-up visits will be necessary to monitor and adjust the device