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BMC Surgery
Published in: BMC Surgery 1/2018

Open Access 01-12-2018 | Research article

Pylorus drainage procedures in thoracoabdominal esophagectomy – a single-center experience and review of the literature

Authors: Stefan Fritz, Katharina Feilhauer, André Schaudt, Hansjörg Killguss, Eduard Esianu, René Hennig, Jörg Köninger

Published in: BMC Surgery | Issue 1/2018

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Abstract

Background

Pylorotomy and pyloroplasty in thoracoabdominal esophagectomy are routinely performed in many high-volume centers to prevent delayed gastric emptying (DGE) due to truncal vagotomy. Currently, controversy remains regarding the need for these practices. The present study aimed to determine the value and role of pyloric drainage procedures in esophagectomy with gastric replacement.

Methods

A retrospective review of prospectively collected data was performed for all consecutive patients who underwent thoracoabdominal resection of the esophagus between January 2009 and December 2016 at the Katharinenhospital in Stuttgart, Germany. Clinicopathologic features and surgical outcomes were evaluated with a focus on postoperative nutrition and gastric emptying.

Results

The study group included 170 patients who underwent thoracoabdominal esophageal resection with a gastric conduit using the Ivor Lewis approach. The median age of the patients was 64 years. Most patients were male (81%), and most suffered from adenocarcinoma of the esophagus (75%). The median hospital stay was 20 days, and the 30-day hospital death rate was 2.9%. According to the department standard, pylorotomy, pyloroplasty, or other pyloric drainage procedures were not performed in any of the patients. Overall, 28/170 patients showed clinical signs of DGE (16.5%).

Conclusions

In the literature, the rate of DGE after thoracoabdominal esophagectomy is reported to be approximately 15%, even with the use of pyloric drainage procedures. This rate is comparable to that reported in the present series in which no pyloric drainage procedures were performed. Therefore, we believe that pyloric drainage procedures may be unwarranted in thoracoabdominal esophagectomy. However, future randomized trials are needed to ultimately confirm this supposition.
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Metadata
Title
Pylorus drainage procedures in thoracoabdominal esophagectomy – a single-center experience and review of the literature
Authors
Stefan Fritz
Katharina Feilhauer
André Schaudt
Hansjörg Killguss
Eduard Esianu
René Hennig
Jörg Köninger
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Surgery / Issue 1/2018
Electronic ISSN: 1471-2482
DOI
https://doi.org/10.1186/s12893-018-0347-x

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