Laparoscopic Revision of Gastric Pacing Wires

Abstract

Currently, electrical stimulation is utilized to treat morbid obesity, gastroparesis, and diaphragmatic paralysis. Although this technology is in its infancy, numerous case reports and small series appear throughout the literature. Furthermore, electrical stimulation is not relegated to only academic centers and tertiary referral centers. As these technologies continue to evolve and alter the treatment of several different pathophysiologic processes, the general surgeon needs to understand the technical aspects of these devices and their potential complications. This paper presents the management of a gastroparetic patient with chronic abdominal pain following the successful placement of gastric pacing wires. A 45-year-old female with idiopathic gastroparesis underwent laparoscopic placement of gastric pacing wires without complications. Four months postoperatively, she presented with chronic left upper quadrant abdominal pain. Her nausea and vomiting had dissipated and she was tolerating a regular diet. Abdominal and pelvic computed tomography (CT) was normal except for the presence of a generator and pacing wires. Ultimately, she required a diagnostic laparoscopy and an upper endoscopy. The upper endoscopy was normal. The diagnostic laparoscopy showed a wide adhesive band from the seromuscular tunnel of the pacing wires to the abdominal wall in the left upper quadrant. The band was lysed and an omental patch was sutured over the insertion site of the wires. On postoperative day 1, the patient was pain-free and discharged home on a regular diet. This case presents an unusual complication of electrical pacing wires. This patient experienced somatic pain due to an adhesive band from her pacing wires to the abdominal wall. Based on the findings of this case, an omental patch was placed on top of the seromuscular electrode tunnel in order to prevent adhesions and potentially persistent abdominal wall pain.