Prevention of early delayed gastric emptying after high-level esophagogastrostomy by "pyloric digital fracture".
OBJECTIVE
This study was designed to evaluate the clinical efficacy of pyloric digital fracture for the prevention of early delayed gastric emptying (DGE) after high-level esophagogastrostomy.


METHODS
From January 2004 to March 2009, we sequentially enrolled 78 patients after esophagogastrostomy: 48 patients with pyloric digital fracture (DF group) and 30 patients without any drainage procedure (non-DF group). Intraoperative manometric study was performed in 48 patients of the DF group. Postoperative evaluation was performed, including symptomatic questionnaire, radiographic study, and gastric scintigraphy.


RESULTS
Intraoperative manometric study revealed that basal pyloric pressure and peak pressure of pylorus in phase III of the migrating motor complex increased significantly after gastric conduit was made and anastomosed, but decreased appreciably following digital fracture. Compared with the peak pressure of IPPW before digital fracture (88.52 ± 19.88 mmHg), it appreciably decreased following digital fracture (40.45 ± 13.52 mmHg). Occurrences of IPPW (in 10 min) and duration time of each occurrence (s) had similar trends for before and after digital fracture (11.5 ± 4.5 vs. 5.0 ± 3.5 and 7.0 ± 2.0 vs. 3.0 ± 1.0, respectively). Postoperative evaluation demonstrated that early DGE occurred in four patients in the non-DF group (13.3%), and there was no DGE patient in the DF group. There was significant difference regarding gastric scores between the DF group and the non-DF group (10.5 ± 3.4 vs. 16.7 ± 3.8, t = 2.8271, P < 0.05). Gastric scintigraphy revealed that either semi-emptying-time or percent of retention at 4 h of the DF group was significantly lower than that of the non-DF group.


CONCLUSIONS
Pyloric digital fracture can prevent early DGE after high-level esophagogastrostomy efficaciously and conveniently.
Deng
Bo
B
Department of Thoracic Surgery, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing city, 400042, People's Republic of China.
Tan
Qun-You
QY
Jiang
Yao-Guang
YG
Zhao
Yun-Ping
YP
Zhou
Jing-Hai
JH
Chen
Guang-Chun
GC
Wang
Ru-Wen
RW
D000714:Anastomosis, Surgical / Q000009:adverse effects*; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D004947:Esophagus / Q000601:surgery*; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D011183:Postoperative Complications; D011708:Pylorus / Q000601:surgery; D011859:Radiography; D019651:Plastic Surgery Procedures / Q000009:adverse effects; D013270:Stomach / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome