ObjectiveThe necessity of pyloroplasty after esophagectomy and gastric pull-up is debated. Disadvantages of a standard pyloroplasty include the potential for leak, added time to the procedure particularly during minimally invasive esophagectomy, shortening of the length of the graft, and perhaps an increased potential for post-operative bile reflux. The aim of this study is to report our experience with a novel internal pyloroplasty technique using a circular stapling device which is applicable to both laparoscopic and open esophagectomy.MethodsRetrospective review of the records of 144 consecutive patients that had esophagectomy and stapled pyloroplasty (SP) from 2002-2008. The SP is performed through a lesser curve gastrotomy with a 21 mm circular stapler that is opened across the pylorus and then closed while pushing the anterior wall of the pylorus downward into the stapler using a suture. The stapler is fired and a bite of the anterior muscular wall of the pylorus is removed, thereby disrupting the pyloric ring. The gastrotomy is excised with tubularization of the stomach.ResultsThe median age of the 144 patients was 63 years, and median follow up was 21 months. The SP technique was used in 117 open and 27 minimally invasive esophagectomies. None of the patients had evidence of a leak clinically or on routine post-operative barium swallow. The pylorus was dilated during subsequent endoscopy for post-operative symptoms in 11/144 (8%) patients. Postoperative dumping syndrome was seen in 2 (1%) patients. No complications related to the procedure have occurred.ConclusionStapled pyloroplasty is an alternative to standard pyloroplasty with esophagectomy and is associated with no graft shortening and no post-operative leak rate. It can be done rapidly during both open and minimally invasive esophagectomy, and may be less disruptive to the pyloric function than a standard pyloroplasty.