Intraoperative Pyloric Botulinum Toxin Injection for Post Total Pancreatectomy With Islet Autotransplantation Gastroparesis Improvement in Children.

[BACKGROUND] Acute Recurrent Pancreatitis (ARP) and Chronic Pancreatitis (CP) may cause abdominal pain, malnutrition, opioid dependency, and impairment in quality of life. Total Pancreatectomy with Islet Autotransplantation (TPIAT) is an option when other measures fail. Pancreatitis gastroparesis can be potentiated by surgery. Botulinum toxin (BT) injections into the pylorus have been used in children for gastroparesis. We evaluated outcomes of pyloric injection of BT for TPIAT in children.

[METHODS] Retrospective cohort of children who underwent TPIAT (2021-2023). Twenty with-BT and 20 without-BT were evaluated for time to achieve full oral nutrition, percent weight change at discharge, days with emesis through post op day 14 (POD14), days when gastrostomy tube (G) required drainage for vomiting through POD14, length of stay (LOS). We hypothesized that pyloric BT during TPIAT would decrease post-operative gastroparesis symptoms.

[RESULTS] CP diagnosis present in 80 % of with-BT & 65 % of the without-BT patients. The groups were similar by sex (with-BT, 45 % male vs 50 % in without-BT). With-BT patients had fewer days to full PO (29.4 (18.3) vs. 40.9 (15.9), p < 0.01), and fewer G tube days (mean 7.2 SD (2.6) vs 10.1(3.4)) (p < 0.01) but no significant difference in emesis days (2.7 (2.8) vs 4.2 (2.9)) (p = 0.21), percent weight change at discharge (-2.9 % (2.7) vs. -4.6 % (2.7)) (p = 0.07) and LOS (median 15.5 IQR(14-16.5) vs. 16 (13.5-19)) (p = 0.46).

[CONCLUSION] Pyloric BT may improve postoperative gastroparesis symptoms among pediatric patients undergoing TPIAT. To our knowledge, this is the first pediatric study evaluating morbidity associated with gastroparesis after TPIAT in an already high-risk population due to ARP or CP.

[TYPE OF STUDY] Retrospective Cohort Study LEVEL OF EVIDENCE: III.