Reply to the letter by L. Bonavina regarding our article “Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction”

2007 ◽  
Vol 393 (1) ◽  
pp. 119-120
Author(s):  
D. Palmes ◽  
M. Weilinghoff ◽  
M. Colombo-Benkmann ◽  
N. Senninger ◽  
M. Brüwer
2007 ◽  
Vol 392 (2) ◽  
pp. 135-141 ◽  
Author(s):  
Daniel Palmes ◽  
Matthias Weilinghoff ◽  
Mario Colombo-Benkmann ◽  
Norbert Senninger ◽  
Matthias Bruewer

2020 ◽  
Vol 102 (9) ◽  
pp. 693-696
Author(s):  
EJ Nevins ◽  
R Rao ◽  
J Nicholson ◽  
KD Murphy ◽  
A Moore ◽  
...  

Introduction The incidence of delayed gastric emptying (DGE) following oesophagogastrectomy with gastric conduit reconstruction is reported to be between 1.7% and 50%. This variation is due to differing practices of intraoperative pylorus drainage procedures, which increase the risk of postoperative biliary reflux and dumping syndrome, resulting in significant morbidity. The aim of our study was to establish rates of DGE in people undergoing oesophagogastrectomy without routine intraoperative drainage procedures, and to evaluate outcomes of postoperative endoscopically administered Botulinum toxin into the pylorus (EBP) for people with DGE resistant to systemic pharmacological treatment. Methods All patients undergoing oesophagogastrectomy between 1 January 2016 and 31 March 2018 at our unit were included. No intraoperative pyloric drainage procedures were performed, and DGE resistant to systemic pharmacotherapy was managed with EBP. Results Ninety-seven patients were included. Postoperatively, 29 patients (30%) were diagnosed with DGE resistant to pharmacotherapy. Of these, 16 (16.5%) were diagnosed within 30 days of surgery. The median pre-procedure nasogastric tube aspirate was 780ml; following EBP, this fell to 125ml (p<0.001). Median delay from surgery to EBP in this cohort was 13 days (IQR 7–16 days). Six patients required a second course of EBP, with 100% successful resolution of DGE before discharge. There were no procedural complications. Conclusions This is the largest series of patients without routine intraoperative drainage procedures. Only 30% of patients developed DGE resistant to pharmacotherapy, which was managed safely with EBP in the postoperative period, thus minimising the risk of biliary reflux in people who would otherwise be at risk following prophylactic pylorus drainage procedures.


1985 ◽  
Vol 24 (03) ◽  
pp. 107-110
Author(s):  
M. Pääkkönen ◽  
S. Aukee ◽  
K. Korhonen ◽  
A. Pääkkönen ◽  
E. Länsimies ◽  
...  

SummaryIn this work the duodenogastric reflux was quantified as the amount of radioactivity entering the stomach after an i.v. administration of 99mmTc-HIDA in ulcer patients and in patients who had undergone BI gastrectomy. The results were compared with visual evidence of gastric activity in the gamma camera images and biochemical determination of gastric bile reflux. The method is useful in quantifying the reflux if the activity is above the background activity. It allows the determination of an upper limit for the reflux when the reflux is evident visually. Only two or three images are needed for the quantitation. No correlation was found between biochemical measurement of fasting bile reflux in the stomach and radioisotopic quantification.


2020 ◽  
Vol 99 (5) ◽  
pp. 200-206

Oesophagectomy is being used in treatment of several oesophageal diseases, most commonly in treatment of oesophageal cancer. It is a major surgical procedure that may result in various complications. One of the most severe complications is anastomotic dehiscence between the gastric conduit and the oesophageal remnant. Anastomotic dehiscence after esophagectomy is directly linked to high morbidity and mortality. We propose a therapeutic algorithm of this complication based on published literature and our experience by retrospective evaluationof 164 patients who underwent oesophagectomy for oesophageal cancer. Anastomotic dehiscence was present in 29 cases.


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