title: Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction.
abstract: OBJECTIVE
  Controversy still exists about the need for pyloric drainage procedures (pyloroplasty or pyloromyotomy) after esophagectomy with esophagogastrostomy and vagotomy. Although pyloric drainage may prevent postoperative delayed gastric emptying, it may also promote bile reflux into the oesophagus. We analysed pyloric drainage methods for their potential effect on gastric outlet obstruction and bile reflux in patients undergoing esophagectomy.
  
  
  METHODS
  One hundred and ninety-eight patients with esophageal carcinoma were treated by transthoracal esophagectomy with gastric conduit reconstruction either with pyloromyotomy (group II, n = 118), pyloroplasty (group III, n = 34) or without pyloric drainage (group I, n = 46) between January 2000 and December 2004. The postoperative gastrointestinal passage by radiological investigation, anastomotic leakage rate, mortality and incidence of gastroesophageal reflux by endoscopy within the first postoperative year were retrospectively analysed.
  
  
  RESULTS
  Patient demographics and the types of surgical procedures did not differ between the three groups. There was no difference in hospital mortality, anastomotic leakage rate, gastrointestinal passage and postoperative hospital stay between the three groups. However, more patients with pyloric drainage showed bile reflux (I = 0% vs II+III=14.9%, p = 0.069) and reflux esophagitis (I = 10.3% vs II+III = 34.5%, p < 0.05) compared to patients without pyloric drainage. On the multivariate analysis, pyloric drainage and the anastomotic height were independent and were significant risk factors associated with postoperative reflux esophagitis.
  
  
  CONCLUSIONS
  Pyloric drainage after esophagectomy with gastric conduit reconstruction should be omitted because it does not improve gastric emptying and may favour biliary reflux esophagitis.
authors.affiliation: Department of General Surgery, Münster University Hospital, Waldeyerstr. 1, 48149, Münster, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Palmes
authors.forename: Matthias
authors.initials: M
authors.lastname: Weilinghoff
authors.forename: Mario
authors.initials: M
authors.lastname: Colombo-Benkmann
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.forename: Matthias
authors.initials: M
authors.lastname: Bruewer
mesh_terms: D000368:Aged; D000714:Anastomosis, Surgical; D003680:Deglutition Disorders / Q000453:epidemiology; D004322:Drainage / Q000379:methods; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D005746:Gastric Emptying; D017219:Gastric Outlet Obstruction; D005764:Gastroesophageal Reflux / Q000453:epidemiology; D006356:Heartburn / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D011708:Pylorus / Q000601:surgery*; D019651:Plastic Surgery Procedures; D013270:Stomach / Q000637:transplantation*; D014628:Vagotomy