Pyloroplasty in gastric replacement of the esophagus after esophagectomy: one-layer or two-layer technique?

Pyloroplasty is our routine drainage procedure performed when the stomach i s used as the esophageal substitute after esophageal resection for cancer. The technique of pyloroplasty varies among surgeons and effectiveness has n ot been studied. Thirty-four patients with a gastric conduit whose pyloropl asty was constructed with a one-layer technique (group 1) were compared wit h a historical cohort of 31 patients treated with a two-layer method (group 2), Patients who had an abnormal pyloroduodenal region were excluded from the study. Perioperative morbidity and post-operative gastrointestinal symp toms within the first 6 months were evaluated, Patient demographics and the types of surgical procedures did not differ between the two groups, The me dian daily output from the nasogastric tube was 119 mL in group 1 and 115 m t in group 2 (p = 0.49), In 40 out of 65 patients (62%), the nasogastric tu be was removed at a median of 3 days after the operation in both groups. Th ere was no leakage from the pylorus or the esophagogastric anastomosis in t his study, In both groups, the patients could resume a semisolid diet at a median of 8 days after surgery. One patient in group 1 and two patients in group 2 developed gastroparesis clinically. No patient, however, required r eoperation. There was no significant difference in cardiopulmonary complica tions attributable to the technique of pyloroplasty. The incidence of gastr ointestinal symptoms within the first 6 months after surgery did not differ . Regurgitation was the most common symptom, affecting 10 patients in each group, 29% and 32% in group 1 and group 2 respectively (p = 1.0), Pyloropla sty was an effective gastric drainage procedure after esophagectomy whether the one or two-layer method was used, The authors prefer the one-layer met hod, which is safe and simple.