Clinical outcomes of intraoperative manual dilatation of pylorus in pylorus-preserving gastrectomy: a retrospective analysis.

Abstract

Delayed gastric emptying is one of the most disturbing complications of pylorus-preserving gastrectomy (PPG) and it increases hospital stay. We investigated the clinical outcome of intraoperative manual dilatation of the pylorus as a preventive method of pyloric spasm after PPG. We reviewed gastric cancer patients who underwent PPG between January 2014 and December 2016 at Seoul National University Hospital by a single surgeon. During operation, manual dilatation (MD) was performed after laparoscopic dissection and gastric resection by mini-laparotomy. Pyloric stenosis was diagnosed by the finding of severe narrowing in pylorus on upper gastrointestinal series (UGIS), if patients suffered from postprandial abdominal fullness and discomfort. Patient's characteristics, surgical data and complication data were reviewed and compared between the groups (MD vs non-MD). 232 patients were included in this study. 93 patients underwent manual dilatation (40.1%). The overall complication rate was 12.9% in the MD group and 18.7% in the non-MD group (p=0.242). Mean postoperative stay was 10.0±5.8 in the MD group versus 10.9±8.4 in the non-MD group (p=0.304). Only one case suffered pylorus stenosis in the MD group (1.1%) but there were twelve cases seen in the non-MD group (8.6%), which reflects a significant difference (p=0.019). Simple intraoperative manual dilatation of pylorus may provide prevention from pyloric stenosis caused by pyloric spasms for patients who undergo PPG.