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Laparoscopic circular stapled longitudinal extramucosal pyloroplasty: an alternative technique for pyloric disruption
Walter Bugiantella1, Fabio Rondelli2, Lorenzo Mariani3
1General Surgery, 'San Giovanni Battista Hospital', Foligno, Italy PhD School in Biotechnologies, University of Perugia, Perugia, Italy walterbugiantella@alice.it.
Objectives:
Oesophagectomy with gastric pull-up is the most common surgical procedure for oesophageal cancer. Pyloroplasty may be performed to facilitate stomach emptying, but its role is still controversial. When laparoscopic mobilization of the stomach is performed, conventional extramucosal pyloroplasty may be difficult to carry out; therefore, we describe a new technique for mechanical pyloric disruption.
Methods:
We conceived the laparoscopic longitudinal extramucosal partial section of the anterior pyloric wall using a circular stapler. We performed it in 6 patients undergoing oesophagectomy for cancer, with the laparoscopic abdominal step before thoracotomy.
Results:
The procedure was easy and safe and without intraoperative complications in all patients. Postoperative video-oesophagogram showed regular anastomosis and graft emptying.
Conclusions:
Our preliminary experience has led us to conclude that circular stapler longitudinal extramucosal pyloroplasty is an easy, safe and quick procedure that can be performed in laparoscopic surgery. Moreover, it seems to ensure a regular emptying of the graft as standard pyloroplasty does.
