Circular stapled pyloroplasty: a fast and effective technique for pyloric disruption during esophagectomy with gastric pull-up

• Published in: Diseases of the esophagus Vol. 24; no. 6; pp. 423 - 429
• Main Authors: Oezcelik, A., DeMeester, S. R., Hindoyan, K., Leers, J. M., Ayazi, S., Abate, E., Zehetner, J., Hagen, J. A., Lipham, J. C., DeMeester, T. R.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.08.2011
• Subjects: Aged; Deglutition Disorders - etiology; Esophageal Neoplasms - surgery; esophagectomy; Esophagectomy - adverse effects; esophagus; Female; Follow-Up Studies; Humans; Male; Middle Aged; pyloroplasty; Pylorus - surgery; stapled pyloroplasty; Stomach - transplantation; Suture Techniques - adverse effects; Suture Techniques - instrumentation
• ISSN: 1120-8694; 1442-2050
• DOI: 10.1111/j.1442-2050.2010.01169.x

SUMMARY 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 66 years, and the median follow‐up was 17 months, 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.