Esophagogastrectomy without pyloroplasty

There is no consensus on the need for pyloroplasty after esophagectomy or proximal gastrectomy with an esophagogastrostomy and vagotomy. Arguments for routine pyloroplasty include prevention of postoperative delayed gastric emptying. Arguments against include prevention of postoperative dumping syndrome and bile reflux esophagitis. The purpose of this study was to assess clinical outcomes of patients undergoing esophagogastrectomy without routine pyloroplasty. All patients undergoing esophagogastrectomy or proximal gastrectomy with esophagogastrostomy from October 1996 to September 2002, inclusive were reviewed for age, gender, diagnosis, type of resection, pathology, short-term complications, long-term complications, remedial procedures performed, and postoperative gastric emptying scintigraphy. 58 patients were studied. Postoperative mortality was 6.9%, and anastomotic leak rate 12.1%. Eleven patients (19%) had symptomatic gastroparesis, two required pyloric balloon dilation and one a pyloroplasty. No patients complained of dumping symptoms; reflux requiring medical intervention occurred in seven (12.1%), and anastomotic stricture requiring dilation occurred in five (8.6%). Omitting a pyloroplasty does not lead to a high frequency of symptomatic delayed gastric emptying. Maintaining the pylorus may protect patients from dumping syndrome, and bile reflux esophagitis with its potential noxious effects on the remaining esophageal mucosa.