Comparison between Finger Bougie of the Pylorus and Pyloroplasty or Pyloromyotomy in Gastric Pull-up Esophageal Surgery

Document Type : Research Paper




ntroduction: In gastric pull-up esophageal surgery, functional obstruction of the pylorus is seen in almost 20% of patients. The purpose of this study was launching finger bougie of pylorus instead of traditional pyloroplasty or pyloromyotomy.
Materials and Methods:This descriptive study carried out from 2002 to 2004 on patients, admitted to the Department of General Surgery of Imam Reza Hospital, Mashhad. Of 58 patients with esophageal cancer, who underwent gastric pull-up esophageal surgery, pyloroplasty or pyloromyotomy was randomly performed on 31 cases (group A), and finger bougie of pylorus (group B) on 24 patients. On the 9th day postoperatively static function of pylorus was evaluated with gastric emptying study. Based on emptying time of the stomach, patients were divided into normal, delayed drainage and complete obstruction groups.Using a questionnaire, individual characteristics, surgical outcome and results of gastric emptying scan were recorded and analyzed by descriptive statistics, frequency distribution tables, Chi-2 and Chi- Square tests.
Results: Of patients, 58 with average age of 58 years old were evaluated from these. 40 cases (69%) were male and 18 cases (31%) were female. Pyloric operations were finger bougie in 31 cases (53/4%), pyloromyotomy in 24 cases (42/4%), and pyloroplasty in 2 cases (3/4%). In 1 case (1/7%) pylorus was intact.Complications were, wound infections in 8 patients (13/8%), cervical fistula in 2 (3.4%) thoracic fistula in 1 (1.7%), chylothorax in 3 patients and tracheal injury in 1 patient. Gastric emptying time was measured in 53 patients with TC99 scanning. The result was normal in 44 cases (75/9%), delayed in 8 cases (13/8%), and gastric outlet obstruction in 1 (1/7%).
Conclusion: Although transhiatal esophagectomy is considered as a palliative procedure, some surgeons prescribe it for all stages of the disease. Most of tracheal injuries are in membranous portion. In small tearing, conservative management with bypassing the site of injury by endotracheal or tracheostomy tube was recommended. Surgery is suggested in large tear or failure of conservative therapy. The first recommendation for fistula in cervical anastomosis is conservative. Early surgery is suggested in complete disruption, non responsive patient after 3 weeks, and intra thoracic fistula. In the present study the results of gastric emptying test in group A (finger bougie of pylorus) and group B (pyloromyotomy or pyloroplasty) were compared. Finger bougie of pylorus in gastric pull-up surgery is preferred and suggested.


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