J Thorac Cardiovasc Surg 2009;137:570-572
© 2009 The American Association for Thoracic Surgery
Discussion
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Dr Ross Bremner
(Phoenix, Ariz). Thank you very much, and congratulations on yet another great presentation and certainly a very interesting and clearly written article.
The optimal drainage procedure for gastric interposition has been debated perhaps even longer than the optimal treatment for stage III lung cancer, but I will try to be brief. The idea of a quick Botox injection is indeed intriguing, and although you do not measure the time it takes to do the Botox procedure versus a formal pyloric procedure, I am sure your conclusion that it is quicker is probably correct. I do have a couple of questions.
How exactly do you do this? How expensive is the drug, and do you know intraoperatively that you have done it adequately? Can you feel that the muscle is now paralyzed?
Dr Cerfolio. Thank you, and those are good questions. We do not put a scope into the stomach and look endoscopically to ensure proper placement, if that is what you mean. We do it by touch. The pylorus is easily palpated. We inject Botox into it in all 4 quadrants, and we are very careful on the side next to the gastroepiploic artery. We inject the Botox in equal parts into all 4 quadrants. Because I had really no baseline to go on, no previous publications on this new idea to read, or anyone to ask, I just curb-sided my gastrointestinal guys and decided to copy what they were doing endoscopically and do it open at the time of laparotomy. You can see the Botox go into the pylorus; you get a little wheal when you are injecting it sort of in the submucosal area, and then I just sort of massage that in like a plastic surgeon does on the forehead. I have talked . . . [Full Text of this Article]
Copyright © 2009 by The American Association for Thoracic Surgery.
