P-195 * PREVENTION OF EARLY GASTRIC EMPTYING AND LATE DUODENO-GASTRO-OESOPHAGEAL REFLUX AFTER OESOPHAGOGASTROSTOMY: IS THERE ONE SOLUTION?

Abstract

Objectives: Controversy exists about the need for pyloric drainage following oesophageal replacement with gastric tube after oesophagectomy for carcinoma of the oesophagus and cardia. Although drainage procedure prevents early postoperative delayed gastric emptying and reduces the incidence of aspiration pneumonia, it promotes duodenal bile reflux and makes gastro-oesophageal reflux more severe and predisposes to dumping at late postoperative period. The objective of this study was to evaluate the effect of different techniques including the "finger pyloric rupture" technique in the prevention of early gastric emptying and duodeno-gastro-oesophageal reflux in patients undergoing oesophagectomy with gastric conduit replacement. Method(s): One hundred and eight patients underwent oesophagectomy with gastric conduit replacement. The intrathoracic stomach emptying (Group 1: 22 patients without drainage, Group 2: 33 patients with pyloromyotomy after Ramshtedt and Group 3: 53 patients with "finger pyloric rupture") was investigated by fluoroscopic film examination and oesophageal reflux by continuing pH-monitoring. Result(s): Results were obtained within 1 postoperative month and 3 months after oesophagectomy Gastric emptying delay was graded as "no delay", "slight or mild" and "moderate or severe" delay. A higher prevalence of moderate to severe delay was observed in the no drainage group (54% and 32% at 1 and 3 months) vs both drainage groups (37% and 18% and 35% and 19% respectively). Mortality (9% vs 3% vs 4%) and morbidity (54% vs 48% vs 47%) were similar in all groups. In the "finger pyloric rupture" group as compared to the no drainage group the prevalence of severe duodeno-gastro-oesophageal reflux (27% and 18% at 1 and 3 months vs 25% and 19% respectively) and the prevalence of dumping syndrome (9% vs 9%) were similar. Conclusion(s): Both pyloric drainage groups are superior to the no drainage group of patients who underwent oesophagogastrostomy in terms of gastric conduit emptying, especially at early period. The "finger pyloric rupture" group shows conversion from bidirectional non-valved conduit to unidirectional sphincter during 3 postoperative months which leads to the same level of severity of duodeno-gastro-oesophageal reflux and dumping syndrome.