Safety of Minimally Invasive Oesophagectomy without Pyloroplasty

Open oesophagectomy may be associated with significant morbidity and mortality. With the increa-sing experiences in laparoscopic and thoracoscopic techniques, minimal invasive approaches to oesophagectomy are being explored to determine the feasibility, results, and potential advantages.

Pyloroplasty is performed during oesophagectomy to avoid delayed gastric emptying and hence reduces the risk of aspiration pneumonia. By contrast, it has been argued that pyloroplasty is unnecessary as gastric outlet obstruction is a rare occurrence following oesophagectomy and that the procedure itself is associated with a number of complications.

Aim: The aim of this study is to assess the safety of minimally invasive oesophagectomy without pyloroplasty.

Methods: Retrospective cohort study was carried out of 90 consecutive surgically fit oesophagogastric cancer patients irrespective to the age and gender having undergone minimally invasive oesophagectomy without pyloroplasty. The outcomes were measured in terms of developing postoperative gastric outlet obstruction or evidence of pyloric stenosis in endoscopy, operative time, intraoperative complications, in hospital and 30 days mortality rate.

Results: 8/90 of minimally invasive oesophagectomy without pyloroplasty developed postoperative gastric outlet obstruction with endoscopic evidence of pyloric stenosis (8.9%). 7/8 with postoperative delayed gastric empyting had been managed conservatively with repeated endoscopic dilatation (87.5%) while one out of eight patient necessitated laparoscopic pyloroplasty (12.5%). Only one among 90 necessitated laparoscopic pyloroplasty .The mean operative time was 366 minutes. 11/90 had postoperative leak (12.2%) which was managed conservatively. The postoperative in hospital mortality was 4/90 (4.4%) and the 30 days mortality is 2/90 (2.2%).

Conclusion: Routine pyrloroplasty is not advocated as the incidence of post operative complication delayed gastric empting, leak, aspiration pneumonia are comparable with pyroloplasty more over pyloroplasty is associated with increased operative time ,so not doing is a safe and a wise decision.