title: Delayed postoperative emptying after esophageal resection is dependent on the size of the gastric substitute.
abstract: BACKGROUND
  Delayed emptying of the gastric substitute is a common problem after resection and reconstruction of the esophagus. The occurrence of postoperative delayed gastric emptying in patients undergoing resection and reconstruction of the esophagus was studied with regard to the type and size of gastric substitute and the execution of a pyloroplasty.
  
  
  METHODS
  From 1983 to 1994, one hundred fifty-five patients underwent resection of the esophagus, with a hospital mortality rate of 7 percent. The inability to resume a diet of solid food within one week after a normal esophagography was defined as delayed gastric emptying. One hundred forty patients were studied; group 1, substitution with whole stomach with (1a, n = 9) and without (1b, n = 31) pyloroplasty; group 2, substitution with distal two-thirds stomach with (2a, n = 20) or without (2b, n = 45) pyloroplasty; and group 3, tubulized stomach without pyloroplasty (n = 35).
  
  
  RESULTS
  Delayed gastric emptying was seen in 38 percent (15 of 40) of patients in group 1 (1a, 44 percent; 1b, 37 percent), in 14 percent (nine of 65) of patients in group 2 (1a, 10 percent; 2b, 15 percent), and in 3 percent (one of 35) of patients in group 3. The differences between patients in group 1 and group 2, and between patients in group 1 and group 3 were significantly different (p < 0.05).
  
  
  CONCLUSIONS
  The type of gastric remnant used for reconstruction is an important determinant of postoperative gastric emptying. Pyloroplasty does not prevent delayed gastric emptying after esophageal substitution.
authors.affiliation: Department of Surgery, Academic Medical Center, University of Amsterdam, The Netherlands.
authors.forename: W A
authors.initials: WA
authors.lastname: Bemelman
authors.forename: C W
authors.initials: CW
authors.lastname: Taat
authors.forename: J F
authors.initials: JF
authors.lastname: Slors
authors.forename: J J
authors.initials: JJ
authors.lastname: van Lanschot
authors.forename: H
authors.initials: H
authors.lastname: Obertop
mesh_terms: D016629:Esophagectomy; D004944:Esophagoplasty; D005260:Female; D005746:Gastric Emptying; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011708:Pylorus / Q000601:surgery; D013270:Stomach / Q000601:surgery*; D013272:Stomach Diseases / Q000601:surgery