Gastric tube with anatomical and functional conservation of the pylorus

INTRODUCTION. There is no consensus as to the carrying out of a procedure of gastric drainage when a subtotal esophagectomy has been performed and the stomach has been replaced by the tubulised denervated esophagus. It is the aim of this study to evaluate the result obtained in patients who underwent subtotal esophagectomy and replacement of the organ by tubulised stomach without applying gastric drainage (pyroloplasty). METHODS. 16 patients treated with this procedure from January 2002 to September 2005 were analyzed. The studied variables were the surgical technique used, the postoperative complications and the presence of symptoms. RESULTS. The resection by McKeown's technique was performed in 50 percent of the cases, whereas the transhiatal access was carried out in 43.8 percent and Ivor Lewis' technique in 6.2 percent. Seven patients (43.8 percent) suffered complications, mainly due to esophagogastric cervical fistula (6 cases). The last of them presented atelactasia and bilateral bronchopneumonia that caused his death. At the six months of follow-up, there were neither symptoms of alkaline reflux nor of difficulty to evacuate the stomach. CONCLUSIONS. The presence of gastric retention or duodenogastric reflux was not proved in this study. However, it is recommendable to conduct a randomized study to compare the results obtained in patients that underwent a procedure of gastric drainage with those whose physiology and anatomy of the denervated pylorus are intact(AU)