The Effect of Esophagectomy and Cervical Esophagogastrostomy with or Without of Pyloromyotomy on Emptying of intrathoracic Stomach

Abstract

AbstractBackground and purpose: A gastric conduit is usually used to reconstruct the foregut after esophagectomy for cancer. The gastric emptying may be impaired after this operation, so some esophageal surgeons routinely add a pyloric drainage procedure. The aim of this study was to determine the emptying of the intrathoracic stomach after esophagectomy and cervical esophagogastrostomy with or without pyloromyotomy.Materials and Methods: Between January 2003 and April 2006, in a randomized controlled trial, 30 patients with esophageal carcinoma were randomized to have with or without pyloromyotomy as a gastric emptying procedure for the gastric conduit used for esophageal replacement. Patterns of gastric emptying in the vagotomized intrathoracic stomach were studied using radioisotope techniques. Gastric emptying (GE) was evaluated 8 weeks after the operation. Patients were available for 6 months follow-up.Results: A total of 30 patients were enrolled in this study. Sixty percent (18) were male, and 40% (12) were female. Twenty three patients (76.7%) had squamous cell carcinoma and 7 (23.3%) had adenocarcinoma. Delayed GE was reported in 11 (73.3%) and normal GE in 4 (26.7%) of patients with Pyloromyotomy. Delayed GE was reported in 9 (60%) and normal GE in 6 (40%) of patients without Pyloromyotomy. There were not any significant differences between complications of post surgery in both groups.Conclusion: These findings were showed that esophageal surgery can be don’t add a pyloric drainage procedure in esophagectomy and cervical esophagogastrostomy and that very few patients actually need it.

Keywords

• Esophageal cancer
• Esophagectomy
• Cervical esophagogastrostomy
• Pyloromyotomy
• Gastric emptying