Does pyloric drainage have a role in the era of minimally invasive esophagectomy? Journal Article
| Authors: | Nobel, T.; Tan, K. S.; Barbetta, A.; Adusumilli, P.; Bains, M.; Bott, M.; Jones, D.; Molena, D. |
| Article Title: | Does pyloric drainage have a role in the era of minimally invasive esophagectomy? |
| Abstract: | Introduction: Pyloric drainage during minimally invasive esophagectomy (MIE) may be more technically challenging than with an open approach. Alternatives to classic surgical drainage have increased in popularity; however, data are lacking to demonstrate whether one technique is superior in MIE. The purpose of this study was to compare post-operative outcomes after MIE between different pyloric drainage methods. Methods: We performed a retrospective review of a prospectively maintained database of patients undergoing MIE at a single academic institution. Patients were divided into three groups for analysis: no drainage, intrapyloric Botulinum Toxin injection, and surgical drainage (pyloroplasty or pyloromyotomy). The primary outcome was any complication within 90 days of surgery; secondary outcomes included reported symptoms and need for pyloric dilation at 6 and 12 months post-operatively. Comparisons among groups were conducted using the Kruskal Wallis and Chi Square tests. Results: There were 283 MIE performed between 2011 and 2017; of these, 126 (45%) had drainage (53 Botulinum injection and 73 surgical). No significant difference in the rate of post-operative complications, pneumonia, or anastomotic leak was observed between groups. At 6 and 12 months, patients that received Botulinum injection and surgical drainage had significantly more symptoms than no drainage (p < 0.0001) and higher need for pyloric dilation at 6 months (p = 0.007). Conclusions: Pyloric drainage was not significantly associated with lower post-operative complications or long-term symptoms. While Botulinum injection appears safe post-operatively, it was associated with increased morbidity long-term. Pyloric drainage in MIE may be unnecessary. © 2018, Springer Science+Business Media, LLC, part of Springer Nature. |
| Keywords: | esophagectomy; post-operative complications; pyloric drainage; pyloric stricture |
| Journal Title: | Surgical Endoscopy |
| Volume: | 33 |
| Issue: | 10 |
| ISSN: | 0930-2794 |
| Publisher: | Springer |
| Date Published: | 2019-10-01 |
| Start Page: | 3218 |
| End Page: | 3227 |
| Language: | English |
| DOI: | 10.1007/s00464-018-06607-8 |
| PUBMED: | 30535543 |
| PROVIDER: | scopus |
| PMCID: | PMC6557699 |
| DOI/URL: | |
| Notes: | Source: Scopus |
Altmetric
Citation Impact
BMJ Impact Analytics
Related MSK Work