Motility across esophageal anastomoses after esophagectomy or gastrectomy

The esophageal motility of 23 patients who underwent esophagectomy or gastrectomy for carcinoma of the esophagus or gastroesophageal junction was recorded daily during the immediate post-operative period for high-pressure transients or other motility disturbances. Patients were divided into three subgroups according to the level of the esophageal anastomosis: group 1, neck (n = 4); group 2, thoracic (n = 14); group 3, diaphragmatic hiatus (n = 5). Peristalsis was absent in all patients studied during ventilation and sedation in the intensive care unit (five patients). Early post-operative esophageal motility after esophageal anastomosis varied somewhat with the length of residual esophagus. With short lengths of residual esophagus, no consistent motility pattern emerged. With longer lengths, early peristaltic activity was evident, but diminished over the first few post-operative days. Esophageal resection and anastomosis is associated with loss of peristalsis in the initial post-operative period, consistent with the concept of an esophageal ileus.