Rescue pyloroplasty for refractory delayed gastric emptying following esophagectomy

Jashodeep Datta, Noel N Williams, R Gregory Conway, Daniel T Dempsey, Jon B Morris
Surgery 2014, 156 (2): 290-7

BACKGROUND: Delayed gastric emptying (DGE) following esophagectomy is a debilitating complication. Rarely, failure of postoperative endoscopic therapy may necessitate rescue pyloroplasty (rPP).

METHODS: We conducted a retrospective, single-institution review of rPP for post-esophagectomy DGE from 2000 to 2013. Pre- and postoperative symptoms and pharmacologic use were examined. "Successful" rPP was defined as resolution of symptoms and pharmacologic requirements postoperatively. Quality of life (QoL) was evaluated by Short Form-12 and study-specific questionnaires.

RESULTS: Thirteen patients underwent open transabdominal rescue Heineke-Mikulicz pyloroplasty. Between esophagectomy and rPP, average interval weight loss was 19 ± 15 lb over 13 months (range, 3-22). Patients underwent 3.4 ± 1.0 preoperative endoscopic balloon dilation (EBD) attempts, with 7 (54%) receiving endoscopic intrapyloric botulinum toxin (IPB) injections. Median follow-up was 12 months (range, 4-23). After rPP, the incidence of nausea, vomiting, bloating, prokinetic use, and total parenteral nutrition/total enteral nutrition dependence decreased (all P < .01). All patients gained weight; 2 developed biliary reflux. Nine of 13 patients were identified as rPP successes; predictors of rPP failure were American Society of Anesthesiologists grade 3 (P = .02), greater number of EBD attempts (P = .02), longer time to rPP (P = .03), and fewer IPB injections (P = .03). QoL assessment revealed general satisfaction with postoperative outcomes and excellent physical and mental functioning.

CONCLUSION: rPP for post-esophagectomy DGE is well-tolerated, results in improvements in symptoms and pharmacologic dependence, and satisfactorily preserves QoL.

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