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Article: Pyloroplasty and pyloromyotomy in gastric replacement of the esophagus after esophagectomy: A randomized controlled trial

TitlePyloroplasty and pyloromyotomy in gastric replacement of the esophagus after esophagectomy: A randomized controlled trial
Authors
Issue Date1997
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jamcollsurg
Citation
Journal Of The American College Of Surgeons, 1997, v. 184 n. 6, p. 630-636 How to Cite?
AbstractBACKGROUND: Drainage methods for the gastric conduit after esophagectomy for carcinoma have been controversial. STUDY DESIGN: In a randomized controlled trial, 92 patients with esophageal carcinoma were randomized to have pyloroplasty or pyloromyotomy as a drainage procedure for the gastric conduit used for esophageal replacement. Only patients who underwent Lewis- Tanner operation or esophagogastrectomy and who had normal pyloroduodenal regions were included. RESULTS: The mean postoperative daily nasogastric output (SEM) were 164 mL (17 mL) in the pyloroplasty group and 179 mL (21 mL) in the pyloromyotomy group (p=not significant). No leakage occurred at the pyloroduodenal region in either group. In both groups, the anastomotic leakage rate was 2 percent, and the in-hospital mortality rate was 7 percent. No significant difference was found in postoperative morbidity and mortality. Gastric outlet obstruction developed in only two patients who underwent pyloromyotomy, and both required reexploration. One died of malignant obstruction of the gastric outlet and aspiration pneumonia. Scintigraphy performed 6 months after operation showed that the median half-life (interquartile range) for gastric emptying was 19 minutes (10 to 24 minutes) in the pyloroplasty group and 8 minutes (5 to 19 minutes) in the pyloromyotomy group (p=0.04). Long-term follow-up up to 5 years, however, did not reveal significant differences between the two groups in the type and quantity of food consumed. The incidence of other symptoms such as regurgitation, diarrhea, bile reflux, and dumping, also was no different. CONCLUSIONS: Pyloroplasty and pyloromyotomy were effective and safe drainage procedures for the gastric conduit used for esophageal replacement. The choice depends on the preference and experience of the surgeon. Most patients adapted to their new conduit with time.
Persistent Identifierhttp://hdl.handle.net/10722/83463
ISSN
2015 Impact Factor: 4.257
2015 SCImago Journal Rankings: 2.604
ISI Accession Number ID

 

DC FieldValueLanguage
dc.contributor.authorLaw, Sen_HK
dc.contributor.authorCheung, MCen_HK
dc.contributor.authorFok, Men_HK
dc.contributor.authorChu, KMen_HK
dc.contributor.authorWong, Jen_HK
dc.date.accessioned2010-09-06T08:41:20Z-
dc.date.available2010-09-06T08:41:20Z-
dc.date.issued1997en_HK
dc.identifier.citationJournal Of The American College Of Surgeons, 1997, v. 184 n. 6, p. 630-636en_HK
dc.identifier.issn1072-7515en_HK
dc.identifier.urihttp://hdl.handle.net/10722/83463-
dc.description.abstractBACKGROUND: Drainage methods for the gastric conduit after esophagectomy for carcinoma have been controversial. STUDY DESIGN: In a randomized controlled trial, 92 patients with esophageal carcinoma were randomized to have pyloroplasty or pyloromyotomy as a drainage procedure for the gastric conduit used for esophageal replacement. Only patients who underwent Lewis- Tanner operation or esophagogastrectomy and who had normal pyloroduodenal regions were included. RESULTS: The mean postoperative daily nasogastric output (SEM) were 164 mL (17 mL) in the pyloroplasty group and 179 mL (21 mL) in the pyloromyotomy group (p=not significant). No leakage occurred at the pyloroduodenal region in either group. In both groups, the anastomotic leakage rate was 2 percent, and the in-hospital mortality rate was 7 percent. No significant difference was found in postoperative morbidity and mortality. Gastric outlet obstruction developed in only two patients who underwent pyloromyotomy, and both required reexploration. One died of malignant obstruction of the gastric outlet and aspiration pneumonia. Scintigraphy performed 6 months after operation showed that the median half-life (interquartile range) for gastric emptying was 19 minutes (10 to 24 minutes) in the pyloroplasty group and 8 minutes (5 to 19 minutes) in the pyloromyotomy group (p=0.04). Long-term follow-up up to 5 years, however, did not reveal significant differences between the two groups in the type and quantity of food consumed. The incidence of other symptoms such as regurgitation, diarrhea, bile reflux, and dumping, also was no different. CONCLUSIONS: Pyloroplasty and pyloromyotomy were effective and safe drainage procedures for the gastric conduit used for esophageal replacement. The choice depends on the preference and experience of the surgeon. Most patients adapted to their new conduit with time.en_HK
dc.languageengen_HK
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/jamcollsurgen_HK
dc.relation.ispartofJournal of the American College of Surgeonsen_HK
dc.rightsNOTICE: this is the author’s version of a work that was accepted for publication in Journal of the American College of Surgeons. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of the American College of Surgeons, [VOL 184, ISSUE 6, 1997]en_HK
dc.subject.meshDrainage - methods-
dc.subject.meshEsophageal Neoplasms - mortality - pathology - surgery-
dc.subject.meshEsophagectomy-
dc.subject.meshPylorus - surgery-
dc.subject.meshStomach Neoplasms - surgery-
dc.titlePyloroplasty and pyloromyotomy in gastric replacement of the esophagus after esophagectomy: A randomized controlled trialen_HK
dc.typeArticleen_HK
dc.identifier.emailLaw, S: slaw@hku.hken_HK
dc.identifier.emailChu, KM: chukm@hkucc.hku.hken_HK
dc.identifier.emailWong, J: jwong@hkucc.hku.hken_HK
dc.identifier.authorityLaw, S=rp00437en_HK
dc.identifier.authorityChu, KM=rp00435en_HK
dc.identifier.authorityWong, J=rp00322en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.pmid9179120-
dc.identifier.scopuseid_2-s2.0-0030994981en_HK
dc.identifier.hkuros25628en_HK
dc.identifier.volume184en_HK
dc.identifier.issue6en_HK
dc.identifier.spage630en_HK
dc.identifier.epage636en_HK
dc.identifier.isiWOS:A1997XC35600010-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLaw, S=7202241293en_HK
dc.identifier.scopusauthoridCheung, MC=37044556200en_HK
dc.identifier.scopusauthoridFok, M=7005879262en_HK
dc.identifier.scopusauthoridChu, KM=7402453538en_HK
dc.identifier.scopusauthoridWong, J=8049324500en_HK

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