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Laparoscopic Placement of Gastric Electro Stimulator

Laparoscopic Placement of Gastric Electro Stimulator. Performed by Jody Johnson, M.D. Presentation by Jonathan Powell, M1. Patient Hx. Female Type 1 diabetes has lead to peripheral neuropathy Resulted in gastroparesis

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Laparoscopic Placement of Gastric Electro Stimulator

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  1. Laparoscopic Placement of Gastric Electro Stimulator Performed by Jody Johnson, M.D. Presentation by Jonathan Powell, M1

  2. Patient Hx • Female • Type 1 diabetes has lead to peripheral neuropathy • Resulted in gastroparesis • Peripheral neuropathy: In this case the patient has diabetic peripheral neuropathy in which the high blood sugar levels damaged her peripheral nerves • Can cause pain (or sometimes lack of sensation) and loss of motor control

  3. Gastroparesis • A stomach disorder in which a full thickness loss of cells of Cajal (neuroconducting cells of the stomach) leads to a decrease in gastric emptying • Stomach muscles function poorly • Food digested slowly, results in a lot of pain • Common causes: • Idiopathic in most cases • Type 1 or 2 diabetes

  4. Treatment of Gastroparesis • Proper nutrition/diet changes: restrict fats, frequent but small meals, lots of fluids • Drugs: • Prokinetic: improve rate of stomach emptying ex. Methylnaltrexone • Antiemetic: control nausea and vomiting, no effect of stomach emptying ex. Prochlorperazine • Surgery: the last resort • Pyroplasty: widening of pyloric valve • Gastric ESTIM

  5. Gastric ESTIM: General Principles • Enterra neurostimulator implanted beneath the skin • Anode and cathode implanted in wall of stomach along the Greater Curvature • Handheld programming device is used to alter the degree and frequency of stimulation (catered to each patient) • Effectiveness has not been demonstrated

  6. Preparation • Scissors • Marilyn dissector • O-suture • 3-O silk R01 Suture • Debakey • Enterra neurostimulator • Two trochars (size 5) • One trochar (size 10) • Laparoscope • Hand held programming device to set frequency and degree of current discharge by the device Patient Position Equipment Used

  7. Patient Position

  8. Procedure • Initial incisions: one midline incision between abdominal quadrants one and two for placement of scope • Two lateral incisions for size 5 trochars (5s are free) • One in each abdominal quadrant

  9. Procedure • ID the pylorus • Deflate stomach • Mark point 10cm along Greater Curve of Stomach starting from pylorus • Insert leads into stomach wall • Caudal lead at 9.5cm from pylorus • Rostral lead at 10.5 cm from pylorus

  10. Procedure • Make pocket at Left mid-quadrant for subcutaneous placement of battery • Externalize leads • Close up • Interrogation: device that, when placed above ESTIM site, can be used to measure battery life and set the current released during each discharge of the device

  11. Post Op Care/Complications • Patient can be sent home that day • Possible complications: • Pain, lack of healing, or infection where device was implanted • Parts of device could wear through skin • Allergic rxn to device • Leads may perforate your stomach or device components may become entangled with or obstruct other internal organs • Tissue damage from improper stimulation setting or malfunction

  12. ESTIM today • Gastric ESTIM is no longer being performed because the effectiveness of this procedure could not be demonstrated • Currently, ESTIM procedures are used for maladies such as: • Xerostomia- dry mouth due to lack of saliva • Intraoral electrostimulation device increases salivary output of Parotid Gland • Function electrical stimulation- use electrical stimulation to activate peripheral nerves affected by paralysis from spinal cord injury, head injury, stroke, etc • Sometimes referred to as neuromuscular electrical stimulation

  13. References • Buckles, MD, Daniel, Jameson Forster, MD, and Richard McCallum, MD. "The Treatment of Gastroparesis in the Age of the Gastric Pacemaker: A Review." Medscape 5.4 (2003): 6. Web. 15 Apr 2011. <http://www.medscape.com/viewarticle/460632>. • "About Gastroparesis." Medtronic. Medtronic Inc., 22 09 2010. Web. 15 Apr 2011. <http://www.medtronic.com/your-health/gastroparesis/index.htm>. • McCallum, MD, Richard, William Snape, MD, Fredrick Brody, MD, and John Wo, MD. "Gastric Electrical Stimulation With Enterra Therapy Improves Symptoms From Diabetic Gastroparesis in a Prospective Study." Clinical Gastroenterology andHepatology 8.11 (2010): 947-954.e1. Web. 15 Apr 2011. <http://www.cghjournal.org/article/s1542-3565(10)00545-8/abstract>. • Douglas, David. "Electrostimulation Relieves Xerostomia." Medscape News (2010): n. pag. Web. 15 Apr 2011.< http://www.medscape.com/viewarticle/731503>. • Abell, MD, Thomas. "Gastric Electrical Stimulation for Medically Refractory Gastroparesis." University of California San Francisco. University of California San Francisco College of Medicine, 2003. Web. 15 Apr 2011. <http://sadieo.ucsf.edu/course/old/Abell1.pdf>.

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