Oesophagogastrostomy without a drainage procedure in oesophageal carcinoma

Abstract

Ten patients with carcinoma of the lower third of the oexophagus who had oesophagogastrectomy followed by oesophagogastrostomy without a drainage procedure were investigated 6 months postoperatively. Postoperative symptomatic evaluation and modified Visick grading of the results were carried out by an independent observer. Objective assessment included fibre-optic endoscopy of the oesophagus, stomach and duodenum, gastric acid secretory studies and measurement of gastric emptying times following the ingestion of a barium food mixture. Eight of the 10 patients had an excellent or very good result and the remaining 2 were graded as satisfactory. No evidence of macroscopic oesophagitis or gastritis was detected and pyloric obstruction was never observed. Gastric emptying time was not prolonged. The results obtained support the concept that a drainage procedure is unnecessary after oesophagogastrostomy.

Disturbed Enterogastric Inhibitory Reflex after Esophageal Resection and Narrow Gastric Tube Reconstruction

“…However, this was not confirmed by a recent study, which is in favor of whole stomach or wide gastric tube interposition [4, 19]. Reduction in the size of the stomach by creating a narrow gastric tube results in a rapid rise in the intragastric pressure after a relatively small meal [23], which may accelerate the emptying of both solid and liquid food.…”

“…In some studies, in which the whole stomach or a wide gastric tube (stomach minus cardia) was interposed, delayed gastric emptying was found [28, 29, 30], although this could not be confirmed by other studies [9, 21, 23, 24, 31, 32]. Our data suggest a wide inter-patient variation in gastric emptying rate of solid food as well as in half emptying time of liquid food in comparison with healthy volunteers (own historical control group with same dual isotope scintigraphic technique, without enteral feeding: n = 16; median GER 32, range 25–42%/h; median T½ 24.5, range 7–62 min; unpublished data).…”

“…The need for pyloroplasty after truncal vagotomy is still a matter of debate [23, 24, 25]. Emptying disorders after whole stomach interposition led to the construction of a narrow gastric tube as the standard esophageal substitute [26, 27], because of the presumed superior functional results [10].…”

Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy☆

“…The quality of life, for long-term survivors, after esophagectomy, may depend on both dietary adaptation and the improvement of intrathoracic gastric motility itself. Delayed emptying of the gastric contents is a common problem after resection and reconstruction of the esophagus [1][2][3][4]. The various preparations of the stomach as an esophageal substitute and the pyloric drainage procedure to prevent gastric stasis secondary to incidental truncal vagotomy have serious effects on gastric emptying.…”

Transposed intrathoracic stomach: Functional evaluation

“…The data regarding gastroscopy findings following gastric transposition is scarce, with a few studies performed only in adults with non-consistent results varying from normal findings in all [28,30] to abnormal findings in all [28][29][30] The relevant data in children is unavailable.…”