Pain After Roux-en-Y Weight Loss Surgery Relieved With SCS
Alexander E. Yakovlev, MD, Angela M. Parmentier, APNP • Comprehensive Pain Management of the Fox Valley, SC 820 East Grant Street, Suite 335 • Appleton, Wisconsin, USA
Background:
In the United States, Roux-en-Y gastric bypass (RYGB) is the most commonly performed procedure for surgical treatment of medically-complicated obesity. The prevalence of chronic abdominal pain post RYGB is approximately 33%.1 The presence of chronic abdominal pain effects diet and exercise and can inhibit progressive weight loss or prevent a patient from maintaining their achieved weight loss goals.
Introduction:
A 35-year-old female patient with a history of morbid obesity treated by Roux-en-Y gastric bypass surgery presented for evaluation and treatment of chronic abdominal pain following a progressive 60 pound weight loss since her bariatric surgery performed within one year. Patient complained of shooting pains in abdomen which were sporadically felt primarily in upper quadrant, inhibiting her from continuing her exercise regimen.
Methods:
Initially celiac plexus block was performed, but relieved the pains only short-term. After various conservative methods trialed without success, she underwent successful trial of percutaneous placement of two 8-electrode epidural leads (Medtronic Inc., Minneapolis, MN). Epidural access was gained at the T12-L1 interspace. Final lead position resulted with lead one at the level of T6, T7, T8, and second lead at the level of T7, T8, T9.
Results:
During SCS trial patient reported greater than 85% improvement of the pain and later underwent placement of permanent leads and a rechargeable generator.
Usage: Patient uses stimulation 24 hours a day
Pain Relief: Reports stimulation present over all areas of pain in abdomen
Opioid Use: Reduced opioid intake by 75%
Non-pain Metrics: Reports improvement of functional capacity, resumed previous exercise regimen, proceeding with further weight loss, reports better sleep, and recently returned to work force
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Conclusion:
Based on the outcome observed, and its reversible nature, SCS represents an attractive treatment option for the management of severe abdominal pain.
Reference:
Bal B, Shope T, Finelli F, Koch T. Prevalence and causes of abdominal pain following fully divided Roux-En-Y Gastric Bypass surgery, Clinical Gastroenterology and Hepatology, 2011; 9 (2) 187.
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