Abstract

Background and Introduction: Gastric stasis following esophagectomy is associated with increased incidence of complications like aspiration pneumonia and anastomotic leak. To date there is no consensus on the routine need for a pyloric drainage procedure for patients undergoing an esophagectomy with gastric conduit reconstruction. In this study, we present a novel method of pyloric drainage which offers the benefit of improved gastric drainage and reduced risk of perioperative complications. 

Methods: A standard Esophagectomy is performed using either, Ivor Lewis esophagectomy, or a Minimally invasive esophagectomy with a cervical anastomosis (McKeown esophagectomy). Stomach tube is made extracorporeally by using linear stapler. Marking of the stomach tube is done. Two linear staplers are fired along the line and an incision is made on the stomach at lesser curvature medial to the marking. A sponge holder is inserted through gastrostomy along the lesser curvature and is passed across the pylorus. The sponge holder is then opened in both longitudinal and transverse planes to cause the fracture of pyloric sphincter. The sponge holder is removed and then the third stapler is fired along the marking to complete the stomach tube. The stomach tube is then pulled up through the posterior mediastinum into the neck and stapler or a hand sewn anastomosis is done between the esophagus and stomach.

Results: We analysed our technique in two hundred and thirty-eight patients with esophageal carcinoma treated by esophagectomy with gastric conduit reconstruction between 2011 and 2016. On analysis postoperative incidence of pulmonary complication is 13% and anastomotic leak rate is 5.8%. Only 2 out 0f 238 patients required postoperative endoscopic balloon dilatation for gastric stasis. 

Conclusions: Our technique of pyloric dilatation is associated with no additional risk to patient and with added advantage of low incidence of pulmonary complications and anastomotic leak.

Keywords: Mesenteric Cysts; Swelling; Abdominal Pain

References

1. Raymond D. “Complications of Esophagectomy”. Surgical Clinics of North America 92 (2012): 1299-1313. 
2. Cheung HC., et al. “Is pyloroplasty necessary in esophageal replacement by stomach? A prospective, randomized controlled trial”. Surgery 102 (1987): 19-24.
3. Gupta S., et al. “Emptying of the intrathoracic stomach with and without pyloroplasty”. The American Journal of Gastroenterology 84 (1989): 921-923.
4. Law S., et al. “Pyloroplasty and pyloromyotomy in gastric replacement of the esophagus after esophagectomy: arandomized controlled trial”. Journal of the American College of Surgeons 184 (1997): 630-636.
5. Kim J H., et al. “Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy”. European Journal of Cardio-Thoracic Surgery 33 (2008): 1105-1111.
6. Kent M S., et al. “A pilot study of botulinum toxin injection for the treatment of delayed gastric emptying following esophagectomy”. Surgical Endoscopy 21 (2007): 754-757.
7. Velanovich V. “Esophagogastrectomy without pyloroplasty”. Diseases of the Esophagus 16 (2003): 243-245.
8. Palmes D., et al. “Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction”. Langenbeck's Archives of Surgery 392 (2007): 135-141.
9. Urschel JD., et al. “Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials”. Digestive Surgery 19 (2002): 160-164.
10. Khan OA., et al. “Does pyloroplasty following esophagectomy improve early clinical outcomes?” Interactive Cardiovascular and Thoracic Surgery 6 (2007): 247-250.
11. Bemelman WA., et al. “A physical model of intrathoracic stomach”. American Journal of Physiology 254-2.1 (1988): G168-G175.
12. Fok M., et al. “Pyloroplasty versus no drainage in gastric replacement of the esophagus”. The American Journal of Surgery 162 (1991): 447-452.
13. Bonavina L., et al. “Functional evaluation of the intrathoracic stomach as an esophageal substitute”. British Journal of Surgery 79 (1992): 529-532.
14. Law S., et al. “Pyloroplasty and pyloromyotomy in gastric replacement of the esophagus after esophagectomy: a randomized controlled trial”. The Journal of the American College of Surgeons 184 (1997): 630-636.
15. Huang GJ and Zhang DW. “A comparative study of resection of carcinoma of the esophagus with and without pyloroplasty. In: Demeester TR, Skinner DB (eds) Esophageal disorders pathophysiology and therapy. Raven, New York (1985): 383-388.
16. Chattopadhyay TK., et al. “Is pyloroplasty necessary following intrathoracic transposition of stomach? Results of a prospective clinical study”. Aust N Z J Surgery 61 (1991): 366-369.
17. Lanuti M., et al. “Post-esophagectomy gastric outlet obstruction: role of pyloromyotomy and management with endoscopic pyloric dilatation”. European Journal of Cardio-Thoracic Surgery 31 (2007): 149-153.
18. S Arya., et al. “The impact of pyloric drainage on clinical outcome following esophagectomy: a systematic review”. Diseases of the Esophagus 28 (2015): 326-335.
19. Nguyen NT., et al. “Outcomes of minimally invasive esophagectomy without pyloroplasty: analysis of 109 cases”. American Surgeon 76 (2010): 1135-1138.
20. Bemelman WA., et al. “Endoscopic balloon dilation of the pylorus after esophagogastrostomy without a drainage procedure”. Surgery, Gynecology and Obstetrics 170 (1990): 424-426.
21. Swanson EW., et al. “Endoscopic pyloric balloon dilatation obviates the need for pyloroplasty at esophagectomy”. Surgical Endoscopy 26 (2012): 2023-2028.

Citation

Citation: Amit Patil., et al. “A Novel Technique for Pyloric Dilatation After Esophagectomy – Our Experience”. Acta Scientific Clinical Case Reports 1.3 (2020): 03-07.

Copyright

Copyright: © 2020 Amit Patil., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.