PYLORIC DRAINAGE VERSUS NO DRAINAGE IN ESOPHAGOGATROSTOMIES AND EVALUATION OF INTRAOPERATIVE BALLOON DILATATION OF PYLORUS: A RANDOMISED CONTROLLED TRIAL.

Background:-. Pyloric drainage procedures are supposed to prevent postoperative delayed gastric emptying but at the same time they may predispose to bile reflux esophagitis and dumping. We undertook this study to make a comparison of pyloric drainage procedures (viz: Heineke-Mikuliczpyloroplasty or intraoperative balloon dilatation of pylorus) with no pyloric drainage procedure, in patients undergoing resection for gastroesophageal junction, gastric cardia and proximal stomach cancers. Methods:- Patients were randomly allocated to surgical procedures vizesophagogastrectomy without a drainage procedure (n=35), esophagogastrectomy with pyloroplasty (n=34) and esophagogastrectomy with intraoperative balloon dilatation of pylorus (n=35). Six months postoperatively patients were subjected to Tc99 gastric emptying scan to evaluate gastric emptying. At 8 months after surgery endoscopy was performed to look for bile reflux esophagitis. Results:- Gastric emptying was delayed in 59.3% of our patients without significant difference among the groups studied. Bile reflux esophagitis was significantly high in pyloroplasty (28.6%) andintaoperaive balloon dilatataion groups (26.7%) as compared to no drainage group (3.6%). Dumping was not found in patients of no drainage group. However in intraoperative balloon dilatation and pyloroplasty groups 21.8% and 18.2% of the patients suffered from dumping respectively which was again significantly high. There was no statistically significant difference in anastomotic leak, pulmonary complications and postoperative hospital stay among the three groups. Conclusion:- Pyloric drainage procedures like Heineke-Mikuliczpyloroplasty and intraoperative balloon dilatation do not significantly improve gastric emptying whileas they promote bile reflux esophagitis and dumping. Also that the intraoperative balloon dilatation has no added advantage over conventional pyloroplasty.