Acta Scientific Clinical Case Reports (ASCR)

Research Article Volume 1 Issue 3

A Novel Technique for Pyloric Dilatation After Esophagectomy – Our Experience

Amit Patil*, Kalyan Chakradhar and Rajesh Mistry

Kokilaben Dhirubhai Ambani Hospital, Mumbai, India

*Corresponding Author:Amit Patil, Kokilaben Dhirubhai Ambani Hospital, Mumbai, India.

Received: March 03, 2020; Published: March 20, 2020

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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

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References

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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.




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