Aim and objective: Spasmo-proxyvon addiction-induced gastric complication has been sparsely discussed in the literature. This study highlights the laparoscopic management of gastric outlet obstruction secondary to spasmo-proxyvon abuse.
Materials and methods: From January 2015 to May 2020, 16 patients presenting with gastric outlet obstruction due to spasmo-proxyvon addiction were managed with laparoscopic truncal vagotomy and gastrojejunostomy. Preoperative data, immediate outcome, and long-term results were analyzed.
Results: All the 16 patients managed with laparoscopic truncal vagotomy and antecolic posterior gastrojejunostomy were male patients. Median age was 36.5 years and median duration of addiction was 25.5 months. The mean operative time was 139.30 minutes. There was no conversion to laparotomy. There was no intra and immediate postoperative mortality. Two patients had delayed gastric emptying in the immediate postoperative period. Median follow-up was 37.30 months. All the patients had significant improvement in oral intake and weight gain. One patient died due to severe anorexia, malnutrition, and generalized anasarca secondary to resumption of drug abuse one year after surgery.
Conclusion: Laparoscopic truncal vagotomy and gastrojejunostomy is a useful mean to manage gastric outlet obstruction secondary to spasmo-proxyvon addiction. This method results in satisfactory perioperative and optimal long-term outcome.
Kohli J. Banned capsules being supplied to entire state, raids in districts likely. Hindustan Times [Internet]. 2014 Jan 31. Available from: https://www.hindustantimes.com/punjab/banned-capsules-being-supplied-to-entire-state-raids-in-districts-likely/storykIIBCZAHpNIRFYbuqamATI.html.
United Nations Office on Drugs and Crime. Rapid situation and response assessment of drugs and HIV in Bangladesh, Bhutan, India, Nepal and Sri Lanka: a regional report [Internet]. 2008 Jun 24. Available from: http://www.unodc.org/pdf/india.
Kozarek RA, Botoman VA, Patterson DJ. Long-term follow-up in patients who have undergone balloon dilation for gastric outlet obstruction. Gastrointest Endosc 1991;36:558–61. DOI: 10.1016/s0016-5107(90)71163-7.
Piper DW, McIntosh JH, Ariotti DE, et al. Analgesic ingestion and chronic peptic ulcer. Gastroenterology 1981;80:427–32. PMID: 7450436.
Appasani S, Kochhar S, Nagi B, et al. Benign gastric outlet obstruction-spectrum and management. Trop Gastroenterol 2011;32:259–66. PMID: 22696905.
Aggarwal A, Noor MT, Kochhar R, et al. Substance induced gastric outlet obstruction-clinical profile and endoscopic outcome. Indian J Gastroenterol 2010;29(suppl 1)109–120. DOI: 10.1007/s12664-010-0062-8.
Kochar R, Kochhar S. Endoscopic balloon dilation for benign gastric outlet obstruction in adults. World J Gastro Endo 2010;2(1): 29–35. DOI: 10.4253/wjge.v2.i1.29.
Khullar SK, DiSario JA. Gastric outlet obstruction. Gastrointest Endosc Clin North Am 1996;6:585–603. PMID: 8803569.
Weaver GA, Rebecca LH, James AS, et al. Nonsteroidal anti-inflammatory drugs are associated with gastric outlet obstruction. J Clin Gastroenterol 1995;20(3):196–198. DOI: 10.1097/00004836-199504000-00006.
Majeed S. Ludhiana: Two drug peddlers arrested, intoxicants seized. The Times of India. [Internet]. 2019 Feb 28. Available from: https://timesofindia.indiatimes.com/city/ludhiana/ludhiana-two-drug-peddlers-arrested-intoxicants-seized/articleshow/68202866.cms.
Bloom BS. Cross-national changes in effects of peptic ulcer disease. Ann Intern Med 1991;114:558–562. DOI: 10.7326/0003- 4819-114-7-558.
Wyman A, Stuart RC, Ng EK, et al. Laparoscopic truncal vagotomy and gastroenterostomy for pyloric stenois. Am J Surg 1996;171:600–603. DOI: 10.1016/s0002-9610(95)00030-5.
Radovanovic N, Simic A, Skrobic O, et al. Highly selective vagotomy and gastrojejunostomy in the treatment of peptic ulcer induced gastric outlet obstruction. Vojnosanit Pregl 2014;71(11):1013–1017. DOI: 10.2298/VSP1411013R.
Csendes A, Malnenda F, Braghetto I, et al. Prospective randomized study comparing three surgical techniques for the treatment of gastric outlet obstruction secondary to duodenal ulcer. Am J Surg 1993;166(1):45–49. DOI: 10.1016/s0002-9610(05)80580-x.
Kim SM, Song J, Oh SJ, et al. Comparison of laparoscopic truncal vagotomy with gastrojejunostomy and open surgery in peptic pyloric stenosis. Surg Endosc 2009;23:1326–1330. DOI:10.1007/s00464-008-0160-1.
Rangarajan M, Subramanian CS, Chandralathan TA. Laparoscopic- assisted truncal vagotomy with antecolic posterior gastrojejunostomy for benign gastric outlet obstruction. Surg Endosc 2006;20:61–63. DOI: 10.1007/s00464-005-0090-0.
Palanivelu C, Jani K, Rajan PS, et al. Laparoscopic management of acid peptic disease. Surg Laparosc Endosc Percutan Tech 2006;16(5):312–6. DOI: 10.1097/01.sle.0000213742.70030.96.
Monga R, Tyagi P, Garg S, et al. Endoscopic management of multiple duodenal diaphragms: case report. Gastrointest Endosc 2003;58: 158–160. DOI: 10.1067/mge.2003.323.
Noor MT, Dixit P, Kochhar R, et al. NSAIDS-related pyloroduodenal obstruction and its endoscopic management. DiagnTher Endosc 2011:967957. DOI:10.1155/2011/967957.
Kochhar R, Malik S, Gupta P, et al. Etiological spectrum and response to endoscopic balloon dilatation in patients with benign gastric outlet obstruction. Amer Soc Gastrointest Endosc 2018 Dec;88(6):899–908. Available from: https://doi.org/10.1016/j.gie.2018.06.037.