role of pyloromyotomy on gastric drainage in esophagectomy and gastric pull-up procedures: a randomized clinical trial study

Introduction: Gastric drainage disorder is one of the complications of gastric pull-up and esophagectomy after surgery which might lead to esophageal cancer and benign strictures. The aim of this study was to determine the role of pyloromyotomy on gastric drainage

Materials and Methods: In this prospective randomized controlled clinical trial study, we studied 51 patients in two matched groups from July 2008 to August 2010 in Imam Reza Hospital, Tabriz,Iran. Twenty-seven patients in group one had no pyloromyotomy and 24 patients in group two had pyloromyotomy after transhiatal esophagectomy and gastric pull-up procedure. The outcomes were measured as the incidence of gastric outlet compromise which was diagnosed 12 months after esophagectomy and gastric pull-up. Regurgitation, fullness, respiratory distress, coughing and, clinical delayed gastric emptying were observed and compared in two groups by radioisotope gastric emptying scanning

Results: A total number of 51 patients, 19 [37.25%] male and 32 [62.75%] female were studied in this research. The overall incidence of delayed gastric emptying was 19 /51 [37.25%]. Pyloromyotomy did not reduce the incidence of delayed gastric emptying. There was no statistically significant difference in the length of hospital stay in study groups [group 1= 11 days versus 12 days in group 2, P=0.41]. There was no statistical difference in anastomotic leak or anastomotic stricture [P= 0.72]. Mortality was two [one patient, 3.7%, in group 1 and one patient, 4.2%, in group 2]. The incidences of regurgitation and increased gastric emptying were not statistically different in two groups

Conclusion: Pyloromyotomy could not reduce the incidence of delayed gastric emptying after transhiatal esophagectomy, and vagotomy

Delayed concurrent chylothorax and chyloperitoneum: report of a case after an old blunt trauma

A 15-year-old boy was referred to Imam Reza Hospital with a right chest tube and chylothorax for 40 days. The patient had respiratory distress and undergone refractory treatment for chylothorax. The fluid content was chyle-rich in lipids. Computed Tomography of the chest showed a large, incompletely evacuated cyst in the left posterior mediastinum with left pleural effusion. The cyst could not be resected through right thoracotomy, because of the left side location of the cyst. Ligation of the thoracic duct through right thoracotomy was not effective in reducing chylous effusion 4 days later. Left chylothorax exacerbated because of the complication of right thoracotomy. Laparatomy was performed to ligate the thoracic duct 6 days later. On exploratory laparatomy, chylous effusion was detected in the peritoneum.Thoracic duct with all the fibro-fatty tissues was ligated below the diaphragm over the spine at 12th to 2nd vertebral spaces. Right chylothorax was resolved after ligation of thoracic duct transabdominally 1-2 days later. Left chylous effusion was decreased and treated 46 days after laparatomy. One year follow up of the patient showed excellent result. In our knowledge, thoracic duct cyst occurring as a result of a delayed chylothorax and chyloperitoneum has not been reported in the literature. Surgical thoracic duct ligation can be the treatment of choice

comparative study of postoperative pulmonary complications using fast track regimen and conservative analgesic treatment: a randomized clinical trial

Postoperative pulmonary complications and pain are important causes of postoperative morbidity following thoracotomy. This study aimed to compare the effects of fast track and conservative treatment regimens on patients undergoing thoracotomy. In this randomized controlled clinical trial, we recruited 60 patients admitted to the thoracic ICU of Imam Reza Hospital in two matched groups of 30 patients each. Group 1 patients received fast track regimen randomly;whereas, group 2 cases randomly received conservative analgesic regimen after thoracotomy and pulmonary resection. The outcome was determined based on the incidence of pulmonary complications and reduction of post-thoracotomy pain in all patients with forced expiratory volume in one second [FEV1] <75% predicted value which was measured while the patients were in ICU. The length of ICU stay, thoracotomy pain, morbidity, pulmonary complications and mortality were compared in two groups. A total of 60 patients, 45 [75%] males and 15[25%] females with ASA class I-III were recruited in this study. Postoperative pulmonary complications were observed in 5 [16.7%] patients in group 1 versus 17 [56.7%] patients in group 2. There were statistically significant differences in development of postoperative pulmonary complications such as atelectasis and prolonged air leak between both groups [P< 0.001 and P=0.003]. There was also a statistically significant difference in the rate of preoperative FEV1 [p=0.001] and ASA scoring [p=0.01] and value of FEV1<75% predicted in the two groups. The difference in length of ICU stay in two groups was statistically significant [P= 0.003 and P=0.017 in FEV1<75% group]. Four patients in group 1 and 9 patients in group 2 had FEV1reduced to less than 75% of predicted value [p=0.03]. Using fast track regimen reduced postoperative pain and incidence of some pulmonary complications significantly when compared to the conservative regimen following thoracotomy and various lung surgeries