The Role of Pyloromyotomy on Gastric Drainage in Esophagectomy and Gastric Pull-up Procedures: A Randomized Clinical Trial Study

Abstract

<strong>Introduction</strong>: Gastric drainage disorder is one of the complications of gastric pull-up and esophagectomy after surgery which might lead to esophageal cancer and benign strictures. The aim of this study was to determine the role of pyloromyotomy on gastric drainage. <br/><strong>Materials and Methods:</strong> In this prospective randomized controlled clinical trial study, we studied 51 patients in two matched groups from July 2008 to August 2010 in ImamRezaHospital, Tabriz,Iran. Twenty-seven patients in group one had no pyloromyotomy and 24 patients in group two had pyloromyotomy after transhiatal esophagectomy and gastric pull-up procedure. The outcomes were measured as the incidence of gastric outlet compromise which was diagnosed 12 months after esophagectomy and gastric pull-up. Regurgitation, fullness, respiratory distress, coughing and, clinical delayed gastric emptying were observed and compared in two groups by radioisotope gastric emptying scanning. <br/><strong>Results:</strong> A total number of 51 patients, 19 (37.25%) male and 32 (62.75%) female were studied in this research. The overall incidence of delayed gastric emptying was 19 /51 (37.25%). Pyloromyotomy did not reduce the incidence of delayed gastric emptying. There was no statistically significant difference in the length of hospital stay in study groups (group 1= 11 days versus 12 days in group 2, P=0.41). There was no statistical difference in anastomotic leak or anastomotic stricture (P= 0.72). Mortality was two (one patient, 3.7%, in group 1 and one patient, 4.2%, in group 2). The incidences of regurgitation and increased gastric emptying were not statistically different in two groups. <br/><strong>Conclusion:</strong> Pyloromyotomy could not reduce the incidence of delayed gastric emptying after transhiatal esophagectomy, and vagotomy.