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Is Gastric Decompression Necessary After Esophagectomy and Esophagogastrostomy
Yang Hu*
Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, China
BACKGROUND:
Gastric decompression(GD) with nasogastric(NG) tube is considered to be necessary after esophagectomy and esophagogastrostomy because it can prevent the dilation of intra-thoracic stomach(ITS) and the postoperational Gastroesophageal reflux(GER). Thus it might be useful to prevent the anastomostic leakage. But the use of NG tube will bring about numerous complications and worsen the gross experience of patients. If we can limite the dilation of intra-thoracic stomach and alleviate GER with tubular gastroplasty and ITS emdedding with a medical sealant glue, is gastric decompression with NG tubes still Necessary?.
METHODS:
150 patients with esophageal cancer were randomly divided into groups with gastric decompression (GD group) and without gastric decompression (NGD group) after surgery. According to the incision chosen, patients in each group were subdivided into Sweet group and Ivor Lewis group. In the operation, all patients received tubular gastroplasty, and a medical sealant glue was used to fix the stomach into mediastinum. The variables recorded for each patient included the gross feeling(with a 1-10 score system), the minimun diameter of ITS on the level of inferior pulmonary vein(with CT), the severity of GER(with Reflux Symptom Questionnaire), the need for placing/replacing the NG tube, the need for gastrointestinal prokinetic drugs, as well as the duration of postoperative hospitalization, pulmonary complications, anastomosis leak.
RESULTS:
After stratified analysis of operation mode, we found the gross feeling of patients is significantly worse in GD group(p<0.05). No difference was found in severity of GER, dilation of ITS, occurrence of complications, as well as the need for gastrointestinal prokinetic drugs and placing/replacing the NG tube between two groups.
CONCLUSIONS:
With the use of tubular gastroplasty and ITS emdedding, Gastric decompression with nasogastric(NG) tube is not necessary to be considered as a routine treatment after esophagectomy and esophagogastrostomy.
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