Skip to main content

Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction


Background and aims

Controversy still exists about the need for pyloric drainage procedures (pyloroplasty or pyloromyotomy) after esophagectomy with esophagogastrostomy and vagotomy. Although pyloric drainage may prevent postoperative delayed gastric emptying, it may also promote bile reflux into the oesophagus. We analysed pyloric drainage methods for their potential effect on gastric outlet obstruction and bile reflux in patients undergoing esophagectomy.

Materials and methods

One hundred and ninety-eight patients with esophageal carcinoma were treated by transthoracal esophagectomy with gastric conduit reconstruction either with pyloromyotomy (group II, n = 118), pyloroplasty (group III, n = 34) or without pyloric drainage (group I, n = 46) between January 2000 and December 2004. The postoperative gastrointestinal passage by radiological investigation, anastomotic leakage rate, mortality and incidence of gastroesophageal reflux by endoscopy within the first postoperative year were retrospectively analysed.


Patient demographics and the types of surgical procedures did not differ between the three groups. There was no difference in hospital mortality, anastomotic leakage rate, gastrointestinal passage and postoperative hospital stay between the three groups. However, more patients with pyloric drainage showed bile reflux (I = 0% vs II+III=14.9%, p = 0.069) and reflux esophagitis (I = 10.3% vs II+III = 34.5%, p < 0.05) compared to patients without pyloric drainage. On the multivariate analysis, pyloric drainage and the anastomotic height were independent and were significant risk factors associated with postoperative reflux esophagitis.


Pyloric drainage after esophagectomy with gastric conduit reconstruction should be omitted because it does not improve gastric emptying and may favour biliary reflux esophagitis.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2
Fig. 3
Fig. 4


  1. Devesa SS, Blot WJ, Fraumeni JF (1998) Changing patterns in the incidence of esophageal and gastric carcinoma in the United States. Cancer 83:2049–2053

    PubMed  Article  CAS  Google Scholar 

  2. Tachibana M, Kinugasa S, Yoshimura H, Shibakita M, Tonomoto Y, Dhar DK, Tabara H, Nagasue N (2004) En-bloc esophagectomy for esophageal cancer. Am J Surg 188:254–260

    PubMed  Article  Google Scholar 

  3. Korst RJ (2005) Surgical resection for esophageal carcinoma: speaking the language. World J Gastroenterol 11:2211–2212

    PubMed  Google Scholar 

  4. Yildirim S, Koksal H, Celayir F, Erdem L, Oner M, Baykan A (2004) Colonic interposition vs gastric pull-up after total esophagectomy. J Gastrointest Surg 8:675–678

    PubMed  Article  Google Scholar 

  5. Lerut T, Coosemans W, DeLeyn P, VanRaemdonck D (2001) Gastroplasty: yes or no to gastric drainage procedure. Dis Esophagus 14:173–177

    PubMed  Article  CAS  Google Scholar 

  6. Visbal AL, Allen MS, Miller DL, Deschamps C, Trastek VF, Pairolero PC (2001) Ivor Lewis esophagogastrectomy for esophageal cancer. Ann Thorac Surg 71:1803–1808

    PubMed  Article  CAS  Google Scholar 

  7. Fok M, Cheng SWK, Wong J (1991) Pyloroplasty versus no drainage in gastric replacement of the esophagus. Am J Surg 162:447–452

    PubMed  Article  CAS  Google Scholar 

  8. Bonavina L, Anselmino M, Ruol A, Bardini R, Borsato N, Peacchia A (1992) Functional evaluation of the intrathoracic stomach as an esophageal substitute. Br J Surg 79:529–532

    PubMed  CAS  Google Scholar 

  9. Law S, Cheung MC, Fok M, Chu KM, Wong J (1997) Pyloroplasty and pyloromyotomy in gastric replacement of the esophagus after esophagectomy: a randomized controlled trial. J Am Coll Surg 184:630–636

    PubMed  CAS  Google Scholar 

  10. Huang GJ, Zhang DW (1985) A comparative study of resection of carcinoma of the esophagus with and without pyloroplasty. In: Demeester TR, Skinner DB (eds) Esophageal disorders pathophysiology and therapy. Raven, New York, pp 383–388

    Google Scholar 

  11. Chattopadhyay TK, Gupta S, Padhy AK, Kapoor VK (1991) Is pyloroplasty necessary following intrathoracic transposition of stomach? Results of a prospective clinical study. Aust N Z J Surg 61:366–369

    PubMed  CAS  Google Scholar 

  12. Urschel JD, Blewett CJ, Young JE, Miller JD, Bennett WF (2002) Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a metaanalysis of randomized controlled trials. Dig Surg 19:160–164

    PubMed  Article  Google Scholar 

  13. Collard JM, Romagnoli R, Otte JB, Kestens PJ (1998) The denervated stomach as an esophageal substitute is a contractile organ. Ann Surg 227:33–39

    PubMed  Article  CAS  Google Scholar 

  14. Johansson J, Sloth M, Bajc M, Walther B (1999) Radioisotope evaluation of the esophageal remnant and the gastric conduit after gastric pull-up esophagectomy. Surgery 125:297–303

    PubMed  CAS  Google Scholar 

  15. Walsh TN, Caldwell MT, Fallon C, McGeown G, Kidney D, Freyne P, Byrne PJ, Hennessy TP (1995) Gastric motility following oesophagectomy. Br J Surg 82:91–94

    PubMed  CAS  Google Scholar 

  16. Gutschow CA, Collard JM, Romagnoli R, Michel JM, Salizzoni M, Hölscher A (2001) Bile exposure of the denervated stomach as an esophageal substitute. Ann Thorac Surg 71:1786–1791

    PubMed  Article  CAS  Google Scholar 

  17. Lindahl H, Rintala R, Sariola H, Louhimo I (1990) Cervical Barrett’s esophagus: a common complication of gastric tube reconstruction. J Pediatr Surg 25:446–448

    PubMed  Article  CAS  Google Scholar 

  18. Bemelman WA, Verburg J, Brummelkamp WH, Klopper PJ (1988) A physical model of the intrathoracic stomach. Am J Physiol 254:G168–175

    PubMed  CAS  Google Scholar 

Download references


Data from this paper were presented at the 41th International Surgical Week in Durban, South Africa, 21–25 August 2005.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Matthias Bruewer.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Palmes, D., Weilinghoff, M., Colombo-Benkmann, M. et al. Effect of pyloric drainage procedures on gastric passage and bile reflux after esophagectomy with gastric conduit reconstruction. Langenbecks Arch Surg 392, 135–141 (2007).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Esophagectomy
  • Pyloroplasty
  • Pyloromyotomy
  • Bile reflux
  • Gastric emptying