Research Of Mechanical Dilatation Of Pyloric Sphincter In Prevention Of Early-Stage Gastric Retention After Radical Esophagectomy

Esophagogastrostomy after radical esophagectomy for esophageal carcinoma or esophago-gastrectomy for cardiac-end gastric carcinoma is one of the most employed procedure. Early-stage postoperative intra-thoracic gastric retention is Very common no matter what approach(right or left postero lateral thoracotomy) we took. It mainly due to the resection of vagus nerve of the stomach which leads to weak peristalsis or dysperistalsis, gastroatonia; temporary pylorospasm due to early-stage inadequate GI decompression or gastric distention after meal. Mild gastric retention would lend to vomiting, short of breath and chest compressed sensation; meanwhile it would lead to the disastrous outcome such as gastric wall necrosis and anastomotic leakage if it become severe. At present, there is no ideal method to prevent the early-stage postoperative gastric retention after radical esophagectomy for esophageal carcinoma and esophago-gastrectomy for cardiac-end gastric carcinoma at home and abroad. Many authors considered that simultaneous pyloroplasty or pyloromyotomy can decrease the occurrence rate of early-stage postoperative gastric retention. But simultaneous pyloroplasty and pyloromyotomy were not easily to be performed because of poorly exposure by left posterolateral thoracotomy during the procedure of esophagectomy practically. Our research are based on this practical situation to perform the intra-operativemechanical pyloric dilatation with the use of mitral commissurotomy dilator in replace of traditional intra-operative pyloromyotomy or balloon dilatation. We expected well outcome in prevention of early-stage postoperative gastric retention in resorting to our method.MATERIALS AND METHODSThe Object:17 cases of esophageal or cardie-end gastric cancer were operated with additonal use of intraoperative mitral commissurotomy dilator to dilatate the pyloric sphinter as trial group betueen October 2001 to January 2002; 17 cases of esophageal or cardie-end gastric cancer were operated without additonal use of intraoperative mitral commissurotomy dilator to dilatate the pyloric sphinter as control group between April 2001 to September 2001. Trial Group:There were 15 male and 2 female patients; aged from 45 to 77 years old. Sixteen patient were fallen with primary esophageal carcinoma while the other one cardiac-end gastric carcinoma. Intra-thoracic esohagogastrostomy were performed in 16 cases while left supraclavicular anastomosis was performed in the other one case. Control group:There were 14 male and 3 female; aged from 50 to 70 years old. Fifteen patients were fallen with primary esophageal carcinoma while the other two cardiac -end gastric carcinoma. Intra-thoracic esohagogastrostomy were performed in 13 cases while left supraclavicular anastomosis was performed in the other four cases.OPERATIVE METHODSTrial group:We performed the radical esophagectomy or esophago-gastrectomy, using the stomach for a conduit and fullydissecting the stomach to pylorus as usual fashion. A mitral commissurotomy dilator was adjusted to a width of 3.0-3.5cm. And it can be passed through the same gastrotomy opening which the E.E.A, instrument was used to perform the stapled anastomosis or the residual orifice of the stomach. It can be easily guided through the pylorus into the duodenum with the operator's hand. The ideal position of the dilator is 1/2-1/3 of the tip passing through the pyloric canal. The dilatating instrument should be passed through the sphincter two to three times. The effectiveness of the procedure can be checked digitally with the index finger to assure adequate dilatation, esophagogastrostomy was finished by manual suturing or anastomat with the gastrointestinal decompression tube passing through the anastomosis by direct vision. Fluid-diet was ordered for 2-5 days after weaning of gastrointestinal decompression which was stayed in position for 3-5 days after surgery. Then semi-liquid diet was ordered. Control group:We performed the radical esophagectomy o...