Presentation on theme: "Laparoscopic Placement of Gastric Electro Stimulator"— Presentation transcript:
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 gastroparesisPeripheral neuropathy: In this case the patient has diabetic peripheral neuropathy in which the high blood sugar levels damaged her peripheral nervesCan cause pain (or sometimes lack of sensation) and loss of motor control
3 GastroparesisA stomach disorder in which a full thickness loss of cells of Cajal (neuroconducting cells of the stomach) leads to a decrease in gastric emptyingStomach muscles function poorlyFood digested slowly, results in a lot of painCommon causes:Idiopathic in most casesType 1 or 2 diabetes
4 Treatment of Gastroparesis Proper nutrition/diet changes: restrict fats, frequent but small meals, lots of fluidsDrugs:Prokinetic: improve rate of stomach emptying ex. MethylnaltrexoneAntiemetic: control nausea and vomiting, no effect of stomach emptying ex. ProchlorperazineSurgery: the last resortPyroplasty: widening of pyloric valveGastric ESTIM
5 Gastric ESTIM: General Principles Enterra neurostimulator implanted beneath the skinAnode and cathode implanted in wall of stomach along the Greater CurvatureHandheld programming device is used to alter the degree and frequency of stimulation (catered to each patient)Effectiveness has not been demonstrated
6 Preparation Patient Position Equipment Used Scissors Marilyn dissector O-suture3-O silk R01 SutureDebakeyEnterra neurostimulatorTwo trochars (size 5)One trochar (size 10)LaparoscopeHand held programming device to set frequency and degree of current discharge by the devicePatient PositionEquipment Used
8 ProcedureInitial incisions: one midline incision between abdominal quadrants one and two for placement of scopeTwo 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 pylorusInsert leads into stomach wallCaudal lead at 9.5cm from pylorusRostral lead at 10.5 cm from pylorus
10 ProcedureMake pocket at Left mid- quadrant for subcutaneous placement of batteryExternalize leadsClose upInterrogation: 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 dayPossible complications:Pain, lack of healing, or infection where device was implantedParts of device could wear through skinAllergic rxn to deviceLeads may perforate your stomach or device components may become entangled with or obstruct other internal organsTissue damage from improper stimulation setting or malfunction
12 ESTIM todayGastric ESTIM is no longer being performed because the effectiveness of this procedure could not be demonstratedCurrently, ESTIM procedures are used for maladies such as:Xerostomia- dry mouth due to lack of salivaIntraoral electrostimulation device increases salivary output of Parotid GlandFunction electrical stimulation- use electrical stimulation to activate peripheral nerves affected by paralysis from spinal cord injury, head injury, stroke, etcSometimes referred to as neuromuscular electrical stimulation
13 ReferencesBuckles, 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 <http://www.medscape.com/viewarticle/460632>."About Gastroparesis." Medtronic. Medtronic Inc., Web. 15 Apr <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): e1. Web. 15 Apr <http://www.cghjournal.org/article/s (10) /abstract>.Douglas, David. "Electrostimulation Relieves Xerostomia." Medscape News (2010): n. pag. Web. 15 Apr 2011.<Abell, MD, Thomas. "Gastric Electrical Stimulation for Medically Refractory Gastroparesis." University of California San Francisco. University of California San Francisco College of Medicine, Web. 15 Apr <http://sadieo.ucsf.edu/course/old/Abell1.pdf>.
Your consent to our cookies if you continue to use this website.