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Creden et al. Mini-invasive Surg 2024;8:21 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2024.19

Review Open Access

Controversies in the management of the pylorus

among patients undergoing robotic-assisted
minimally invasive esophagectomy

Samuel P. Creden, Shawn S. Groth

Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA.
Correspondence to: Dr. Shawn S. Groth, Division of Thoracic Surgery, Michael E. DeBakey Department of Surgery, 7200
Cambridge St, Ste 6A, Houston, TX 77030, USA. E-mail: Shawn.Groth@bcm.edu
How to cite this article: Creden SP, Groth SS. Controversies in the management of the pylorus among patients undergoing
robotic-assisted minimally invasive esophagectomy. Mini-invasive Surg 2024;8:21. https://dx.doi.org/10.20517/2574-1225.
2024.19

Received: 27 Feb 2024 First Decision: 2 Aug 2024 Revised: 19 Aug 2024 Accepted: 18 Sep 2024 Published: 9 Oct 2024
Academic Editors: Farid Gharagozloo, Giulio Belli Copy Editor: Pei-Yun Wang Production Editor: Pei-Yun Wang

Abstract
Bilateral truncal vagotomies are intrinsic to nearly all esophagectomies, rendering patients susceptible to delayed
gastric emptying. The question of whether, how, and when to perform pyloric drainage is essential and remains
controversial in the era of robotic-assisted minimally invasive esophagectomy. While a variety of pyloric
intervention techniques have been described, selective endoscopic pyloromyotomy for post-esophagectomy
patients with durable signs of delayed gastric emptying is an attractive option, given its low morbidity rate,
particularly its low incidence of dumping.

Keywords: Robotic-assisted surgery, esophagectomy, pyloromyotomy

INTRODUCTION
While there is no agreed-upon single best approach for esophagectomy, bilateral truncal vagotomies are
intrinsic to nearly all esophagectomies, rendering patients susceptible to impaired gastric emptying. The
question of whether, how, and when to perform pyloric drainage is thus essential, yet remains controversial
as it has been unaddressed by randomized trials. Indeed, the literature has yet to definitively support any
[1-3]
strategy over another . Several management strategies have been proposed: surgical pyloromyotomy,
surgical pyloroplasty, endoscopic pyloric dilatation, chemodenervation with onabotulinum toxin, and (most

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
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