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RESEARCH ARTICLE
Laparoscopic Management of Gastric Outlet Obstruction

Secondary to Spasmo-proxyvon Addiction

1
Mohit Sharma , Rachhpal Singh 2

AbstrAct
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 the16 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.
Keywords: Gastric outlet obstruction, Gastrojejunostomy, Laparoscopy, Spasmo-proxyvon addiction, Truncal vagotomy.
World Journal of Laparoscopic Surgery (2021): 10.5005/jp-journals-10033-1467

IntroductIon 1 Department of Surgery, Sri Guru Ram Das Institute of Medical Sciences
Spasmo-proxyvon is a popular brand of antispasmodic analgesic and Research, Amritsar, Punjab, India
from Wockardt. It contains acetaminophen (400 mg), dicyclomine 2 Department of Surgery, Sri Guru Ram Das Hospital, Amritsar, Punjab,
(10 mg), and dextropropoxyphene (400 mg). It comes in the India
category of banned drug but is available illegally as a gelatin Corresponding Author: Mohit Sharma, Department of Surgery, Sri
1
capsule and is of rampant abuse in Punjab. A regional report from Guru Ram Das Institute of Medical Sciences and Research, Amritsar,
Indian subcontinent reported the abuse of propoxyphene in 64% Punjab, India, Phone: +91 9814651788, e-mail: drmohit.gis@gmail.com
2
of male drug abusers. The heavy ingestion of acetaminophen is How to cite this article: Sharma M, Singh R. Laparoscopic Management
associated with peptic ulceration of stomach with a potential to of Gastric Outlet Obstruction Secondary to Spasmo-proxyvon
3,4
cause gastric outlet scarring. Similarly, frequent use of opium Addiction. World J Lap Surg 2021;14(3):183–185.
or its derivatives is associated with gastric outlet obstruction. 5,6 Source of support: Nil
Gastric outlet obstruction is defined as the obstruction in the Conflict of interest: None
antropyloric region or in the bulbar or postbulbar duodenal
7
segment. We report our experience in the laparoscopic
management of gastric outlet obstruction secondary to spasmo-
proxyvon addiction.

MAterIAls And Methods
This study is the retrospective analysis of prospectively collected
data of spasmo-proxyvon addict patients admitted with complaints
of abdominal pain, persistent vomiting, and bleeding in surgical
ward of a tertiary hospital from January 2015 to May 2020. Patients
diagnosed with pyloric antrum perforation, ulcer bleed, and
severely malnourished cases requiring feeding jejunostomy were
excluded from the analysis. Records of 16 patients with feature
of gastric outlet obstruction managed with laparoscopic truncal
vagotomy and gastrojejunostomy were analyzed. All patients
were managed in a multidisciplinary set up comprising medical
gastroenterologist, surgical gastroenterologist, psychiatrist, and
nutritional therapist. All patients with symptoms of gastric outlet
obstruction were evaluated with upper G.I endoscopy (Fig. 1) Fig. 1: Pyloric stenosis

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