title: Circular stapled pyloroplasty: a fast and effective technique for pyloric disruption during esophagectomy with gastric pull-up.
abstract: The necessity of pyloroplasty after esophagectomy and gastric pull-up is debated. Disadvantages of a standard pyloroplasty include the potential for leak, shortening of the length of the graft, and complexity when done during a minimally invasive procedure. The aim of this study is to report our experience with a novel internal pyloroplasty technique using a circular stapler (CS pyloroplasty), which is applicable for both laparoscopic and open esophagectomy. The records of all patients who underwent an esophagectomy with gastric pull-up and pyloroplasty between 2002 and 2007 were reviewed. The CS pyloroplasty was performed through a lesser curve gastrotomy with a 21-mm CS, while the standard pyloroplasty entailed a longitudinal full thickness incision through the pylorus with mucosal closure in the same direction and a Graham patch. A CS pyloroplasty was performed in 144 and a standard pyloroplasty in 133 patients. The median patient age was 66years, and the median follow-up was 17months, and was similar for both types of pyloroplasty. Routine postoperative videoesophagram was significantly more likely to show a delay in contrast transit through the pylorus after standard pyloroplasty (16% standard vs. 8% CS pyloroplasty, P= 0.03). Significantly more patients had postoperative endoscopy after standard pyloroplasty (40% standard vs. 24% CS pyloroplasty, P= 0.004), but the frequency of pyloric dilatation was similar. There were no leaks with either technique. A circular stapled pyloroplasty is as efficacious as a standard pyloroplasty after esophagectomy with gastric pull-up. Potential advantages include the ease and simplicity of the procedure along with virtually no risk of a leak and no graft shortening. The technique is amenable to both open and minimally invasive procedures.
authors.affiliation: Department of Surgery, University of Southern California, Keck School of Medicine, Los Angeles, California 90033, USA.
authors.forename: A
authors.initials: A
authors.lastname: Oezcelik
authors.forename: S R
authors.initials: SR
authors.lastname: DeMeester
authors.forename: K
authors.initials: K
authors.lastname: Hindoyan
authors.forename: J M
authors.initials: JM
authors.lastname: Leers
authors.forename: S
authors.initials: S
authors.lastname: Ayazi
authors.forename: E
authors.initials: E
authors.lastname: Abate
authors.forename: J
authors.initials: J
authors.lastname: Zehetner
authors.forename: J A
authors.initials: JA
authors.lastname: Hagen
authors.forename: J C
authors.initials: JC
authors.lastname: Lipham
authors.forename: T R
authors.initials: TR
authors.lastname: DeMeester
mesh_terms: D000368:Aged; D003680:Deglutition Disorders / Q000209:etiology; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011708:Pylorus / Q000601:surgery*; D013270:Stomach / Q000637:transplantation; D013536:Suture Techniques / Q000009:adverse effects / Q000295:instrumentation