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

Background and 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. 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. 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. 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.