Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

The Optimal Pyloric Procedure: A Collective Review

  • Kim, Dohun (Department of Thoracic and Cardiovascular Surgery, Chungbuk National University Hospital, Chungbuk National University College of Medicine)
  • Received : 2020.05.06
  • Accepted : 2020.06.10
  • Published : 2020.08.05
Download PDF
⟨ Previous Next ⟩

Abstract

Vagal damage and subsequent pyloric denervation inevitably occur during esophagectomy, potentially leading to delayed gastric emptying (DGE). The choice of an optimal pyloric procedure to overcome DGE is important, as such procedures can lead to prolonged surgery, shortening of the conduit, disruption of the blood supply, and gastric dumping/bile reflux. This study investigated various pyloric methods and analyzed comparative studies in order to determine the optimal pyloric procedure. Surgical procedures for the pylorus include pyloromyotomy, pyloroplasty, or digital fracture. Botulinum toxin injection, endoscopic balloon dilatation, and erythromycin are non-surgical procedures. The scope, technique, and effects of these procedures are changing due to advances in minimally invasive surgery and postoperative interventions. Some comparative studies have shown that pyloric procedures are helpful for DGE, while others have argued that it is difficult to reach an objective conclusion because of the variety of definitions of DGE and evaluation methods. In conclusion, recent advances in interventional technology and minimally invasive surgery have led to questions regarding the practice of pyloric procedures. However, many clinicians still perform them and they are at least somewhat effective. To provide guidance on the optimal pyloric procedure, DGE should first be defined clearly, and a large-scale study with an objective evaluation method will then be required.

Keywords

References

  1. Mamie M. Pyloric dyskinesia following surgical lesions of the vagus nerve. Gastroenterologia 1967;108:2-9. https://doi.org/10.1159/000201575
  2. Klein MS, Sherlock P. Gastric stasis and esophagitis following vagectomy without pyloroplasty, Am J Gastroenterol 1973;59:321-6.
  3. Nakamura Y, Nakayama T, Mitomi T, Ueda M, Kaitsu N. Clinical study on pyloroplasty and myotomy of the pylorus in surgery of esophageal cancer. Shujutsu 1967;21:899-910.
  4. Collard JM, Romagnoli R, Otte JB, Kestens PJ. The denervated stomach as an esophageal substitute is a contractile organ. Ann Surg 1998;227:33-9. https://doi.org/10.1097/00000658-199801000-00005
  5. Johansson J, Sloth M, Bajc M, Walther B. Radioisotope evaluation of the esophageal remnant and the gastric conduit after gastric pullup esophagectomy. Surgery 1999;125:297-303. https://doi.org/10.1016/S0039-6060(99)70240-0
  6. Walsh TN, Caldwell MT, Fallon C, et al. Gastric motility following oesophagectomy. Br J Surg 1995;82:91-4. https://doi.org/10.1002/bjs.1800820131
  7. Urschel JD, Blewett CJ, Young JE, Miller JD, Bennett WF. Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials. Dig Surg 2002;19:160-4. https://doi.org/10.1159/000064206
  8. Ramstedt C. Zur operation der angeborenen pylorusstenose. Med Klin 1912;8:1702.
  9. Van der Bilt JD, Kramer WL, van der Zee DC, Bax NM. Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: impact of experience on the results in 182 cases. Surg Endosc 2004;18:907-9. https://doi.org/10.1007/s00464-003-9075-z
  10. Schuster SR, Colodny AH. A useful maneuver to simplify pyloromyotomy for hypertrophic pyloric stenosis. Surgery 1964;55:735-6.
  11. Binet A, Klipfel C, Meignan P, et al. Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a survey of 407 children. Pediatr Surg Int 2018;34:421-6. https://doi.org/10.1007/s00383-018-4235-3
  12. Costanzo CM, Vinocur C, Berman L. Postoperative outcomes of open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis. J Surg Res 2018;224:240-4. https://doi.org/10.1016/j.jss.2017.08.040
  13. Keeley JL. Transverse incision for pyloromyotomy. Surg Gynecol Obstet 1949;89:748-51.
  14. Dacha S, Mekaroonkamol P, Li L, et al. Outcomes and quality-of-life assessment after gastric per-oral endoscopic pyloromyotomy (with video). Gastrointest Endosc 2017;86:282-9. https://doi.org/10.1016/j.gie.2017.01.031
  15. Mohan BP, Chandan S, Jha LK, et al. Clinical efficacy of gastric peroral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: a systematic review and meta-analysis using surgical pyloroplasty as a comparator group. Surg Endosc 2020;34:3352-67. https://doi.org/10.1007/s00464-019-07135-9
  16. Podboy A, Hwang JH, Nguyen LA, et al. Gastric per-oral endoscopic myotomy: current status and future directions. World J Gastroenterol 2019;25:2581-90. https://doi.org/10.3748/wjg.v25.i21.2581
  17. Anderson MJ, Sippey M, Marks J. Gastric per oral pyloromyotomy for post-vagotomy-induced gastroparesis following esophagectomy. J Gastrointest Surg 2020;24:715-9. https://doi.org/10.1007/s11605-019-04418-3
  18. Collard JM, Romagnoli R, Otte JB, Kestens PJ. Erythromycin enhances early postoperative contractility of the denervated whole stomach as an esophageal substitute. Ann Surg 1999;229:337-43. https://doi.org/10.1097/00000658-199903000-00006
  19. Mikulicz JV. Zur operativen behandlung des stenosirenden magengeschwures. Arch Klin Chir 1888;37:79-90.
  20. Finney JM. A new method of pyloroplasty. Bull Johns Hopkins Hosp 1902;13:155-61.
  21. Shada AL, Dunst CM, Pescarus R, et al. Laparoscopic pyloroplasty is a safe and effective first-line surgical therapy for refractory gastroparesis. Surg Endosc 2016;30:1326-32. https://doi.org/10.1007/s00464-015-4385-5
  22. Davis BR, Sarosiek I, Bashashati M, Alvarado B, McCallum RW. The long-term efficacy and safety of pyloroplasty combined with gastric electrical stimulation therapy in gastroparesis. J Gastrointest Surg 2017;21:222-7. https://doi.org/10.1007/s11605-016-3327-4
  23. Bugiantella W, Rondelli F, Mariani L, Mariani E. Laparoscopic circular stapled longitudinal extramucosal pyloroplasty: an alternative technique for pyloric disruption. Interact Cardiovasc Thorac Surg 2015;21:143-6. https://doi.org/10.1093/icvts/ivv116
  24. Loreta P. Intorno alla divulsione digitale del pilore; osservazione cliniche. Mem Accad Sc 1st Bologna 1882;4:353-75.
  25. Kim JH, Lee HS, Kim MS, Lee JM, Kim SK, Zo JI. Balloon dilatation of the pylorus for delayed gastric emptying after esophagectomy. Eur J Cardiothorac Surg 2008;33:1105-11. https://doi.org/10.1016/j.ejcts.2008.03.012
  26. Deng B, Tan QY, Jiang YG, et al. Prevention of early delayed gastric emptying after high-level esophagogastrostomy by "pyloric digital fracture". World J Surg 2010;34:2837-43. https://doi.org/10.1007/s00268-010-0766-z
  27. Eldaif SM, Lee R, Adams KN, et al. Intrapyloric botulinum injection increases postoperative esophagectomy complications. Ann Thorac Surg 2014;97:1959-65. https://doi.org/10.1016/j.athoracsur.2013.11.026
  28. Bagheri R, Fattahi SH, Haghi SZ, et al. Botulinum toxin for prevention of delayed gastric emptying after esophagectomy. Asian Cardiovasc Thorac Ann 2013;21:689-92. https://doi.org/10.1177/0218492312468438
  29. Cerfolio RJ, Bryant AS, Canon CL, Dhawan R, Eloubeidi MA. Is botulinum toxin injection of the pylorus during Ivor-Lewis esophagogastrectomy the optimal drainage strategy? J Thorac Cardiovasc Surg 2009;137:565-72. https://doi.org/10.1016/j.jtcvs.2008.08.049
  30. Lanuti M, DeDelva P, Morse CR, et al. Management of delayed gastric emptying after esophagectomy with endoscopic balloon dilatation of the pylorus. Ann Thorac Surg 2011;91:1019-24. https://doi.org/10.1016/j.athoracsur.2010.12.055
  31. Burt M, Scott A, Williard WC, et al. Erythromycin stimulates gastric emptying after esophagectomy with gastric replacement: a randomized clinical trial. J Thorac Cardiovasc Surg 1996;111:649-54. https://doi.org/10.1016/S0022-5223(96)70318-5
  32. Nakabayashi T, Mochiki E, Garcia M, et al. Gastropyloric motor activity and the effects of erythromycin given orally after esophagectomy. Am J Surg 2002;183:317-23. https://doi.org/10.1016/S0002-9610(02)00796-1
  33. Lanuti M, de Delva PE, Wright CD, et al. Post-esophagectomy gastric outlet obstruction: role of pyloromyotomy and management with endoscopic pyloric dilatation. Eur J Cardiothorac Surg 2007;31:149-53. https://doi.org/10.1016/j.ejcts.2006.11.010
  34. Mekaroonkamol P, Shah R, Cai Q. Outcomes of per oral endoscopic pyloromyotomy in gastroparesis worldwide. World J Gastroenterol 2019;25:909-22. https://doi.org/10.3748/wjg.v25.i8.909
  35. Fok M, Cheng SW, Wong J. Pyloroplasty versus no drainage in gastric replacement of the esophagus. Am J Surg 1991;162:447-52. https://doi.org/10.1016/0002-9610(91)90258-F
  36. Antonoff MB, Puri V, Meyers BF, et al. Comparison of pyloric intervention strategies at the time of esophagectomy: is more better? Ann Thorac Surg 2014;97:1950-8. https://doi.org/10.1016/j.athoracsur.2014.02.046
  37. Zieren HU, Muller JM, Jacobi CA, Pichlmaier H. Should a pyloroplasty be carried out in stomach transposition after subtotal esophagectomy with esophago-gastric anastomosis at the neck?: a prospective randomized study. Chirurg 1995;66:319-25.
  38. Palmes D, Weilinghoff M, Colombo-Benkmann M, Senninger N, Bruewer M. Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction. Langenbecks Arch Surg 2007;392:135-41. https://doi.org/10.1007/s00423-006-0119-4
  39. Nguyen NT, Dholakia C, Nguyen XM, Reavis K. Outcomes of minimally invasive esophagectomy without pyloroplasty: analysis of 109 cases. Am Surg 2010;76:1135-8. https://doi.org/10.1177/000313481007601026
  40. Fritz S, Feilhauer K, Schaudt A, et al. Pylorus drainage procedures in thoracoabdominal esophagectomy: a single-center experience and review of the literature. BMC Surg 2018;18:13. https://doi.org/10.1186/s12893-018-0347-x
  41. Gaur P, Swanson SJ. Should we continue to drain the pylorus in patients undergoing an esophagectomy? Dis Esophagus 2014;27:568-73. https://doi.org/10.1111/dote.12035
  42. Arya S, Markar SR, Karthikesalingam A, Hanna GB. The impact of pyloric drainage on clinical outcome following esophagectomy: a systematic review. Dis Esophagus 2015;28:326-35. https://doi.org/10.1111/dote.12191
  43. Wente MN, Bassi C, Dervenis C, et al. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007;142:761-8. https://doi.org/10.1016/j.surg.2007.05.005

Cited by

  1. Response to the Comment on “Randomized Comparison of Gastric Tube Reconstruction With and Without Duodenal Diversion Plus Roux-en-Y Anastomosis After Esophagectomy” by Dr Ahmed et al. vol.274, pp.6, 2020, https://doi.org/10.1097/sla.0000000000004660