Application of mechanical dilatation of the pyloric sphincter in esophagectomy for esophageal carcinoma.

The objective of this study was to investigate the effectiveness of additional intraoperative mechanical dilatation of the pyloric sphincter in order to prevent early postoperative gastric retention after esophagectomy using the stomach as substitute for esophageal carcinoma patients. Between October 2001 and May 2002, 32 consecutive esophageal carcinoma patients were treated with esophagectomy combined with additional intraoperative mechanical dilatation of pyloric sphincter (trial group). Another 30 patients underwent esophagectomy without additional intraoperative mechanical dilatation of the pyloric sphincter (control group). Both groups were compared in the following aspects: amount of postoperative GI drainage, time of flatus, intrathoracic gastric fluid retention and other surgical related complications. The amount of GI drainage in the trial group was significantly less than that in the control group (p < 0.05), and time of anal exsufflation was 1 to 2 days. X-ray demonstrated only 0 to 25% of intrathoracic gastric fluid retention and no related complications such as anastomotic leakage, so the patients in the trial group suffered less gastric reflux. Additional intraoperative mechanical dilatation of the pyloric sphincter in radical esophagectomy can accelerate gastric emptying, the recovery of gastric-intestinal function and obviously decrease the occurrence of early postoperative gastric retention and related complications. This method does have the advantages of ease of performance, confirmed effectiveness and safety. It can be utilized in radical esophagectomy through any approach of thoracotomy.