700例冠状动脉旁路移植术的临床回顾

作者对阜外医院７００例冠状动脉旁路移植术（ＣＡＢＧ）患者的临床资料和手术结果，按时间分Ａ、Ｂ两组进行对比分析，结果显示合并糖尿病、高血脂症、心功能Ⅲ～Ⅳ级、左主干病变、广泛三支病变等在患者中所占比例近三年有显著的增高（Ｐ＜０．０５）；合并高血压病（４１．３％）、陈旧性心肌梗塞（６５．０％）、有左室室壁瘤（２４．３％）、术后需使用ＩＡＢＰ（９．４％）发生率高，但两组间无显著性差异。心肌保护方法的改进、冠状动脉充分再血管化技术的提高和内乳动脉的广泛采用，使术后早期死亡率（Ｂ组９．６％，Ａ组２．７％）及围术期心梗发生率（Ｂ组９．０％、Ａ组３．２％，Ｐ＜０．００５）明显下降。     

肝硬变胃十二指肠溃疡手术治疗

目的 提高伴肝硬化的胃十二指肠溃疡手术疗效。方法 回顾性总结１９７５～１９９４年间行伴肝硬化的胃，十二指肠溃疡手术治疗１５６例。结果 治愈１３４例（８５．９％），死亡２２例（１４．１％）均死于术后并发症，多种并发症者死亡率高于有１种并发症者（Ｐ〈０．０５），急诊手术的死亡率高于择期手术（Ｐ〈０．０５）。术前有肾功能障碍死亡率最高（６０％），伴有门静脉高压症者１２２例死亡１６例（１３．１％）白球蛋白     

肝外伤诊断和治疗的改进

为探讨钝性肝外伤时改进诊断和治疗对降低并发症和死亡率的影响，分析了１９５１～１９９６年间长海医院１８０例肝外伤的资料。全组有钝性伤１５２例和开放伤２８例。结果显示：腹腔穿刺诊断钝性肝外伤的阳性率为９２．９％（１０５／１１３），急症室超声检查的阳性率为９６．２％（２５／２６）。治疗方法包括３例非手术治疗和１７７例手术治疗。总并发症发生率、治愈率和总死亡率分别为３２．８％（５９／１８０），８５．６％（１５４／１８０）和１４．４％（２６／１８０）。比较前期（１９５１～１９８８年）与近期（１９８９～１９９６年）的资料，通过近年在诊断和治疗上的改进，并发症发生率有显著差异（Ｐ＜０．０５），死亡率有非常显著差异（Ｐ＜０．０１）。讨论了急症室超声检查对钝性肝外伤早期诊断的价值、非手术治疗的利弊、手术方式的选择和并发症的预防     

胆源性胰腺炎手术时机的探讨

目的探讨胆源性胰腺炎（ＧＰ）的手术时机。方法采用统计学方法分析了５３例ＧＰ的临床资料。结果早期手术组（入院４８小时内）及延期手术组（入院４８小时后）并发症发生率分别为２９．２０％和３．５０％（Ｐ＜０．０５）;死亡率分别为８．３０％和０（Ｐ＜０．０５）。ＡＰＡＣＨＥ－Ⅱ记分≤８的轻型ＧＰ死亡率与手术时机无关,但早期手术组的并发症发生率（１１．１０％）及胆总管探查率（９１．７０％）明显高于延期手术组（Ｐ＜０．０５）。ＡＰＡＣＨＥ－Ⅱ记分＞８的重型ＧＰ并发症发生率及死亡率与手术时机有关,即早期手术组明显高于延期手术组。结论轻型ＧＰ应待急性发作缓解后延期手术;重型ＧＰ应采用延期与个体化相结合的处理原则。     

经尿道前列腺切除术1000例分析评估

对１９７８年６月以来新施行的１０００例良性前列腺增生症（ＢＰＨ）行经尿道前列腺切除术（ＴＵＲＰ）者进行了分析评估，结果临床症状改善者９７５例（９７．５％），效果不良者２０例（２．０％），死亡５例（０．５％），其中１９９０年以后的５２７例仅占１例死亡（０．１９％），其并发症总发生率为１０．１％，其中Ａ组为１４．２％，Ｂ组为６．５％，文中还分析了讨论了发生并发症的原因及影响手术效果的因素，并对ＴＵＲＰ     

蝶骨嵴脑膜瘤诊治的进一步探讨

作者将近１２年来收治的７２例蝶骨嵴脑膜瘤按是否采用显微技术、肿瘤部位及疗效进行了比较分析。内侧型肿瘤全切除率，显微手术组和非显微手术组分别为６５％和２０％（Ｐ＜０．０１）；外侧型肿瘤全切除率分别为１００％和７７％（Ｐ＞０．０５％）。显微手术组和非显微手术组死亡率分别为６．７％和１１．９％（Ｐ＞０．０５）；手术致残率分别为３３．３％和６４．３％（Ｐ＜０．００１）；长期随访患者优良率；内侧型肿瘤分别为８７．５％和１６．７％（Ｐ＜０．０５）；外侧型肿瘤分别为６６．７％和７５％（Ｐ＞０．０５）。作者认为，ＣＴ、脑血管造影及显微外科技术的应用有助于提高本病的诊疗水平。     

脾肾静脉分流术的临床应用

作者为推荐脾肾静脉分流术，分析对比了４０５例脾肾静脉分流术及３７６例脾切除术的临床资料，分流术术后再出血者为１０．１２％，切脾组为２１．２％（Ｐ＜０．００１），出血导致死亡者切脾组高于分流组，分别为１０．６％与２．９６％。但因肝衰死亡者分流组高于切脾组，分别为１６．５％与９．８％。分流术后门静脉压力下降及食管静脉曲张改善均优于切脾组（Ｐ＜０．０１）。根据不同病因分析，肝炎后肝硬变分流术对防止再出血的效果在随访期更明显，分流组为８．６％，切脾组为２２．７％（Ｐ＜０．０２）。近期肝衰的发生分流组高于切脾组为８．９％与３．２％（Ｐ＜０．００１）。为了提高脾肾静脉分流术的效果，严格手术指征是降低术后肝衰发生的关键。为了防止再出血，熟练精细的手术操作起到关键作用。预防性脾肾静脉分流术术后再出血为４．９％，切脾组为１５．１％（Ｐ＜０．０１）。因出血致死者在预防性分流组为６．２％，切脾组为２６．４％。分流组不增加脑病及肝衰的发生率，又可避免继发性肝外阻塞。为了纠正传统端侧吻合术的缺陷，采用改良的侧侧吻合法操作简便，损伤小，又有良好的分流效果，现已成为常规的手术方式。     

105例急性肢体动脉阻塞的临床治疗分析

作者总结１９８２年３月～１９９６年９月收治的１０５例急性肢体动脉阻塞患者的临床诊断与治疗体会。对因栓塞与血栓形成两种不同原因患者的治疗结果进行比较：栓塞组肢体救治率８６．８％，高于血栓形成组５７．９％（Ｐ＜０．０１）；而血栓形成组死亡率８％，低于栓塞组１５．７％（Ｐ＜０．０１）。结果表明：两种不同病因所致急性肢体动脉阻塞发病机制不同导致肢体救治率和死亡率有很大区别。     

肺转移性肿瘤的外科疗效分析

作者对５８例肺转移性肿瘤行肺切除术５９例次，２例剖胸探查活检，手术近期死亡率６．６％。出院５２例，随访６个月～２５年。原发肿瘤控制，转移肿瘤作手术切除者中，术后１年、３年、５年累积生存率分别为７６．８％、３７．９％和１８．０％。临床分析结果提示多个转移瘤术后生存率低于单个转移瘤（Ｐ＜０．０５）；肿瘤倍增时间与术后生存期长短高度相关（ｒ＝０．８４６０）。     

急性坏死性胰腺炎211例治疗经验

为确立急性坏死性胰腺炎（ＡＮＰ）的治疗方案，作者对比研究了以早期手术为主的Ａ组（１９９２年以前的１２２例）和以早期非手术治疗为主的Ｂ组（１９９２年以后７５例，１９９２年以前１４例，共计８９例）患者的并发症发生率和死亡率。结果Ｂ组并发症（ＡＲＤＳ、肾衰、心衰）的发生率和死亡率明显低于Ａ组（Ｐ＜０．０１）。对ＡＮＰ的治疗采取早期非手术治疗明显优于早期手术治疗。作者讨论了非手术治疗的方法、非手术治疗期中转手术的指征、及ＡＮＰ的治疗方案。     

Palliative gastroenterostomy for pancreatic cancer

The records of 125 consecutive patients with unresectable pancreatic cancer treated between 1958 and 1979 were evaluated to determine the benefit or morbidity of gastroenterostomy performed on a routine basis. One hundred three patients had no evidence of gastric outlet obstruction from tumor extension as determined at the time of initial operation. Fifty-seven of these patients underwent biliary diversion as their only operative procedure. The morbidity and mortality in this group was 31 and 14 percent, respectively. Six of these 57 patients required decompressing gastroenterostomy at a later date to relieve gastric outlet obstruction. Forty-six patients underwent both biliary and prophylactic gastric outlet diversion with a 15 percent mortality rate and a 46 percent incidence of morbidity. The most common complication in this group was delayed gastric emptying (14 percent). These findings, and the high incidence of delayed gastric emptying after gastroenterostomy and the relatively infrequent occurrence of gastric outlet obstruction (11 percent) after initial biliary diversion, suggest that gastroenterostomy should be performed on a selective basis only.     

Postoperative acute pancreatitis as a major determinant of postoperative delayed gastric emptying after pancreaticoduodenectomy

The aim of this study was to prospectively analyze the possible association of delayed gastric emptying and postoperative pancreatic complications after pancreaticoduodenectomy. Although hospital mortality after pancreaticoduodenectomy is minimal, morbidity is still high; delayed gastric emptying is one of the most frequent complications. Thirty-nine consecutive patients undergoing pancreaticoduodenectomy were included in this study: 14 females and 25 males (median age 65 years; range, 7–82). Delayed gastric emptying was defined as the need for a nasogastric tube or recurrent vomiting that prevented normal feeding on the 10th postoperative day. Blood analysis was performed on postoperative days 4, 6, and 10; Gastrografin examination on day 6; CT scan on days 2 and 5; and drain amylases were measured on day 5. Pancreatitis was defined as pancreatitis changes in CT scan interpreted by an experienced radiologist without knowing other data. Pancreatic fistula was defined according to the recent international recommendations. We had no mortality. Twelve patients (31%) developed delayed gastric emptying. Surgical (9/12 vs. 5/27; P=0.001) but not medical complications occurred more often in the delayed gastric emptying group. Of the single complications, postoperative CT-detected pancreatitis (6/12 vs. 4/27; P=0.03) and postoperative pancreatic fistula (5/12 vs. 1/27; P=0.0007) were significantly associated with delayed gastric emptying compared with the patients without delayed gastric emptying. This pancreatitis was already detected in CT scan on day 2 in most patients (6/10, 60%). In delayed gastric emptying patients, the only parameters in blood analysis that differed significantly from patients without this complication were serum amylase activity (mean±SEM, 715±205 vs. 152±70 IU/L; P=0.02), blood leukocyte count (16±2 vs. 9±0.6 × 10⁹/L; P=0.007) and serum C-reactive protein (CRP) concentration (144±28 vs. 51±14 mg/L, P=0.01). Postoperative pancreatic (subclinical) fistula was also associated with postoperative pancreatitis (6/10 vs. 0/29; P=0.003). Preoperative coronary artery disease (OR=16; 95% CI, 1.0-241; P=0.05) and soft pancreatic texture at operation (OR=9; 95% CI, 1.4-52; P=0.02) were significant risk factors for the development of postoperative pancreatitis. The diagnosis of delayed gastric emptying after pancreaticoduodenectomy often follows postoperative pancreatitis. Delayed gastric emptying is also associated with postoperative pancreatic fistula, for which this pancreatitis seems to be a risk factor. Preoperative coronary artery disease and soft texture of the pancreas are significant risk factors for postoperative CT-detected pancreatitis. Supported by the Medical Research Fund of Tampere University Hospital, Pirkanmaa Hospital District, Finland (S.R.).     

Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization

HYPOTHESIS: Experience with pancreatic resection for the last 10 years has resulted in new trends in patient characteristics and, for pancreaticoduodenectomy (PD), a decrease in the length of stay (LOS). This decrease is due in part to the implementation of case management and clinical pathways. DESIGN: Retrospective case series of patients undergoing pancreatic resection. SETTING: A university-affiliated, tertiary care referral center. PATIENTS: The study comprised 733 consecutive patients undergoing pancreatic resection for benign or malignant disease at the Massachusetts General Hospital in Boston from April 1990 to March 2000. INTERVENTIONS: Of the 733 pancreatic resections, 489 were PD; 190, distal pancreatectomy; 40, total pancreatectomy; and 14, middle-segment pancreatectomy. MAIN OUTCOME MEASURES: Length of stay; occurrence of delayed gastric emptying, pancreatic fistula, reoperation, readmission, or other complications; mortality; and comparison of patients in 3 periods according to the implementation of case management (July 1995) and clinical pathways (September 1998). RESULTS: For PD, patients in group 1 (April 1990 to June 1995) were significantly younger (mean +/- SD, 57 +/- 15 years) than those in group 2 (July 1995 to August 1998; mean +/- SD, 62 +/- 13 years) and group 3 (September 1998 to October 2000; mean +/- SD, 65 +/- 13 years)(P <.01). Over time, the proportion of PD for cystic tumors increased from 9.9% to 20% (P =.01), and the proportion of PD for chronic pancreatitis decreased from 23% to 10% (P <.01). Use of pylorus-preserving PD decreased from 45% to 0% (P <.001). Delayed gastric emptying decreased from 17% to 6.1% (P <.01). Pancreatic fistula, reoperation, and mortality were unchanged. Length of stay for PD decreased from 16.1 +/- 0.6 to 9.5 +/- 0.4 days (mean +/- SE) (P <.001). Multivariate analysis showed that period, case volume, pylorus-preserving PD, and presence of complications are all independent predictors of LOS (P <.05 for all). For distal pancreatectomy, patients in groups 2 and 3 were older than those in group 1 (mean +/- SD, 57 +/-14 vs 52 +/- 17 years) (P <.05). Resections for cystic tumors increased from 26% to 52% (P <.05), and resections for chronic pancreatitis decreased from 32% to 14% (P =.06). Median LOS decreased from 9 days to 6. For total pancreatectomy, resections for cystic tumors increased from 18% to 43%. Median LOS decreased from 14.5 days to 11. For all resections, case volume increased from 4 resections per month in 1990 to 5.8 in 1995 and 12 in 2000 (r = 0.83; P <.001). CONCLUSIONS: Older patients are increasingly being selected for pancreatic resection. This reflects an increasing frequency of operations performed for cystic tumors and fewer for chronic pancreatitis. With the exception of delayed gastric emptying, complications and mortality have remained the same or decreased slightly during the past 10 years. However, there has been a significant decrease in LOS; this is the result of implementation of case management and clinical pathways, increasing case volume, decreasing incidence of delayed gastric emptying, and decreasing use of pylorus-preserving PD.     

A vertical stomach reconstruction after pylorus-preserving pancreaticoduodenectomy.

BACKGROUND: Pancreatic fistula (PF) and delayed gastric emptying (DGE) is a leading cause of morbidity after pylorus-preserving pancreaticoduodenectomy (PPPD), occurring in 20% to 40% of patients. METHODS: Between August 1994 and March 2000, 30 consecutive patients underwent our modified PPPD and were evaluated on their incidence of PF and DGE. The major modification of our technique was an antecolic reconstruction and setting the transverse colon between pancreaticogastrostomy and duodenojejunostomy RESULTS: Operative time and blood loss were, respectively, 5.2+/-0.93 hours and 730+/-330 mL. Hospital mortality was 0%. Postoperative morbidity was 23%. Delayed gastric emptying and pancreatic fistula were observed in 3 (10%) and 0 (0%) of 30 patients. Nasogastric suction was required for 7+/-2 days, and a solid diet could be tolerated on postoperative day 11+/-4. CONCLUSIONS: The results show that our reconstruction can minimize DGE.     

Palliative surgery for unresectable pancreatic and periampullary cancer: a reappraisal

This study aimed to reappraise short-term and long-term results of palliative biliary and gastric bypass surgery in patients with unresectable pancreatic head carcinoma found at explorative laparotomy. We retrospectively analyzed 83 consecutive patients whose pancreatic head carcinoma appeared unresectable at laparotomy (vascular involvement [57%], liver metastases [24%], distant metastatic lymph nodes [11%], peritoneal implants [8%]) and who underwent palliative surgical concomitant biliary and gastric bypass. Postoperative mortality and morbidity rates were 4.8% and 26.5%, respectively. Postoperativedelayed gastric emptying occurred in 9 patients (10%). Antecolic (46%) and retrocolic (54%) gastrojejunostomies did not differ for the duration of nasogastric suction, the delay of oral intake, and the incidence of delayed gastric emptying. Mean hospital stay was 16 +- 8 days. Median survival was 9 months (range 1–44). Late cholangitis occurred in 2 patients (2.4%) treated medically. One recurrent jaundice required transhepatic stenting 9 months from surgery. Four late gastric outlet obstructions occurred (4.8%) with a mean delay of 8 months from surgery. These data demonstrate that, in patients with unresectable pancreatic head carcinoma at laparotomy, palliative concomitant biliary and gastric bypass in a single procedure is safe and long-term efficient. This strategy remains to be compared to endoscopic palliation in this setting.     

食管胃吻合术后胃排空障碍探讨

目的　探讨食管胃吻合术后胃排空障碍的原因、合理的预防措施及其有效的治疗方法。方法　回顾性分析我科 1982年 1月～ 2 0 0 2年 4月间 32例食管胃吻合术后胃排空障碍病人的临床资料。结果　 32例胃排空障碍病人 ,食管胃颈部吻合 2 4例 ,胸腔内吻合 8例。占同期食管癌手术 1378例的 2 .3%。 2 5例功能性胃排空障碍病人中 2 2例经保守治愈 ,1例死亡 ,死亡率为 4 .0 % ;7例机械性胃排空障碍病人经手术治愈。结论　胃排空障碍多见于高位食管胃吻合术后 ,以食管胃颈部吻合者多见 ,其发生与手术操作和术后处理不当有关 ,胃排空障碍多为功能性 ,少数为机械性。前者大多可经保守治疗而痊愈 ,后者则必须手术解除梗阻。本文还对食管癌术后胃排空障碍的定义、诊断与鉴别诊断进行了探讨     

Prevalence of gastroparesis before and after lung transplantation and its association with lung allograft outcomes

The main cause of late morbidity and mortality after lung transplantation is bronchiolitis obliterans syndrome (BOS). This study assesses the prevalence of gastroparesis among lung-transplant recipients and its association with BOS. The files of 139 patients who underwent nuclear gastric emptying studies before and/or three and 12 months after lung transplantation were reviewed, and the correlation of gastric emptying time (GET) at each time point with the occurrence of acute rejection or BOS (stage 0p or higher) was evaluated. Delayed gastric emptying (DGE; t(1/2) > 90 min) was documented in 50% of patients before transplantation - 74% at three months and 63% at 12 months. Median pre-transplant t(1/2) was 108 min in patients who acquired BOS and 77 min in BOS-free patients (p = 0.022). Among patients with pre-transplant DGE, 58% were BOS-free at 24 months post-operatively and 37% at 36 months; corresponding rates in patients with normal motility were 78% and 63% (p = 0.084). On multiple regression analysis adjusting for other measures of upper gastrointestinal dysfunction, GET before or three months after transplantation was significantly associated with BOS (OR 1.05 [95% CI 1.01-1.09] and OR 1.001 [1.001-1.005] per minute t(1/2)). Gastroparesis is common in lung-transplant recipients and associated with the development of BOS.     

Pancreaticoduodenectomy – outcomes from an Australian institution

Background: Operative morbidity and mortality rates have improved markedly since the first single‐stage pancreaticoduodenectomy (PD) was performed by A. O. Whipple in 1940. There is a lack of published data regarding outcomes of PD from Australian centres. The aim of this study was primarily to establish post‐operative morbidity and mortality rates of an Australian unit, and secondly, to investigate the value of preoperative investigation with endoscopic ultrasound and laparoscopy upon tumour stage and survival following PD. Method: A retrospective analysis was conducted on consecutive patients undergoing PD at St Vincent's Hospital from 1990 to 2006. Data were collected with particular reference to preoperative investigations, including endoscopic ultrasonography (EUS) and staging laparoscopy, and post‐operative complications. Patient survival was determined from the hospital and consultant surgeons' records and telephone interviews with the patients' general practitioners. Results: Eighty‐one patients underwent PD, of which 58 were Whipple's procedures and 23 were pylorus‐preserving pancreaticoduodenectomies (PPPD). Twenty‐six patients had EUS, and 22 had a staging laparoscopy before PD. The post‐operative morbidity rate was 55% and included intra‐abdominal collections (17%), major haemorrhage (10.7%), pancreatic anastomotic leakage (9%) and delayed gastric emptying (22%). The operative (30‐day) mortality rate was 1.6%. There was no survival advantage in the EUS or the laparoscopy group. Conclusion: EUS and laparoscopy are useful modalities in the preoperative investigation and staging of patients being considered for PD. PD is a safe procedure with acceptable complication rates when carried out in a specialist unit experienced in this operation.     

电针足三里穴对大鼠40％血容量失血口服补液时胃排空和胃血流量的影响

目的：研究电针足三里穴对40％血容量失血大鼠早期口服葡萄糖-电解质液（GES）时胃排空和胃血流量的影响。方法：雄性SD大鼠随机分为口服GES组（GES,n=16）;失血＋口服GES＋电针非经非穴组（H4-GEs／SEA,n=16）和失血＋口服GES4-电针足三里穴组（H4-GES／EA,n=16）。大鼠用氯胺酮-速眠新Ⅱ肌肉注射复合麻醉后,行右侧颈动脉插管,按全身血容量的40％分两次间隔15min放血制作失血性休克模型。于失血后0．5h及1h分两次给予2倍失血量的GES灌胃。需电针治疗的大鼠用自制布袋固定后,于第二次灌胃后在清醒状态下电针足三里穴（频率2～100Hz,强度2～3mA,时间30min）。非经非穴组于失血口服GES后刺激非经非穴（足三里穴外侧旁开0．5cm,频率2～100Hz,强度2～3mA,时间30min）。用激光多谱勒血流仪测定失血后2h和4h胃组织血流量,采用酚红法测定胃排空率。结果：失血后2h和4h,H4-GEs／SEA组胃排空率分别为（42．2±7．8）％和（62．4±11．4）％,显著低于GES组（86．8±7．2）％和（92．4±12．5）%（P均〈0．01）;胃血流量分别为（80．091±42．200）U和（94．641±9．442）U,显著低于GES组（161．760±38．277）U和（146．010±17．512）U（P均〈0．01）。H＋GES／EA组失血后2h和4h胃排空率比H4-GES／SEA组提高34．0％和18．0％;胃血流量增加17．0％和12．6％（P〈0．05或P〈0．01）。结论：电针足三里穴能显著增加大鼠失血性休克早期胃排空率和胃血流量,提高口服液体复苏的效果。     

Pyloric drainage (pyloroplasty) or no drainage in gastric reconstruction after esophagectomy: a meta-analysis of randomized controlled trials

BACKGROUND/AIM: A gastric conduit is usually used to reconstruct the foregut after esophagectomy for cancer. The gastric emptying may be impaired after this operation, so some esophageal surgeons routinely add a pyloric drainage procedure (pyloroplasty or pyloromyotomy). We performed a meta-analysis of randomized controlled trials (RCTs) to determine the effect of pyloric drainage on patient outcomes. METHODS: Medline and manual searches were done (completed independently and in duplicate) to identify all published RCTs that addressed the issue of pyloric drainage procedures during gastric conduit reconstruction of the esophagus. The selection process was inclusive; no trials were excluded. Trial validity assessment was done, and a trial quality score was assigned. Early outcomes assessed by meta-analysis included operative mortality, esophagogastric anastomotic leaks, pulmonary morbidity, pyloric drainage complications, fatal pulmonary aspiration, and gastric outlet obstruction. A random-effects model was used, and the relative risk was the principal measure of effect. Systematic semiquantitative review was used for late outcomes such as gastric emptying, bile reflux, nutritional status, and obstructive foregut symptoms. RESULTS: Nine RCTs, that included a total of 553 patients, were selected, with quality scores ranging from 1 to 4 (5-point Jadad scale). Selection and validity agreement was strong. The relative risk (95% CI; p value), expressed as pyloric drainage versus no drainage (treatment vs. control), was 0.92 (0.34, 2.44; p = 0.86) for operative mortality, 0.90 (0.47, 1.76; p = 0.77) for esophagogastric anastomotic leaks, 0.69 (0.42, 1.14; p = 0.15) for pulmonary morbidity, 2.55 (0.34, 18.98; p = 0.36) for pyloric drainage complications, 0.25 (0.04, 1.60; p = 0.14) for fatal pulmonary aspiration, and 0.18 (0.03, 0.97; p = 0.046) for gastric outlet obstruction. Systematic semiquantitative review showed a nonsignificant trend favoring pyloric drainage for the late outcomes of gastric emptying, nutritional status, and obstructive foregut symptoms. For the late outcome of bile reflux, there was a nonsignificant trend favoring the no-drainage group. The scintographic gastric emptying time, expressed as a ratio (pyloric drainage/no drainage), was 0.53. CONCLUSIONS: Data synthesized from existing RCTs show that pyloric drainage procedures reduce the occurrence of early postoperative gastric outlet obstruction after esophagectomy with gastric reconstruction, but they have little effect on other early and late patient outcomes.