Pyloroplasty

Pyloroplasty, OPS-2019 5-43 Incision, excision, and resection of the stomach, is the medical term used to describe an operation in which a narrowed stomach outlet is widened to facilitate gastric emptying. The procedure is one of the drainage operations.^[1][2]

Indication

Pyloroplasty may be indicated in:^[1]

• Gastric outlet stenosis
• Duodenal ulcer
• pre-stomach pull
• together with a fundoplication

Operating principle

The first documented surgery was performed in 1886 by Walter Hermann von Heineke^[3][4], and in 1888 Johann von Mikulicz performed a similar operation for a gastric ulcer. After these two surgeons, the procedure used is called pyloroplasty according to Heineke-Mikulicz.^[5]

The procedure can be performed laparoscopically or openly.

There are different surgical techniques:^[2][1]

• Pyloromyotomy according to Ramstedt-(Weber): longitudinal section of the annular musculature at the pylorus and distension without opening the mucosa, in hypertrophic pyloric stenosis of the infant^[6]
• Pyloroplasty according to Heineke-Mikulicz: longitudinal incision and transverse closure of the pylorus, dilatation plasty^[7]
• Pyloroplasty according to Finney: longitudinal section of the pylorus and the anterior end of the duodenum, side-to-side anastomosis (gastroduodenostomy)^[8]
• Pyloroplasty according to Jaboulay: opening of the stomach above and the duodenum below the pylorus, side-to-side anastomosis with bypassing of the pylorus^[9]

Often the procedure is combined with a vagotomy.^[10]

An alternative may be balloon dilatation if indicated.^[11]

Literature

• S. Ono, F. Yano, M. Hoshino, N. Mitsumori, K. Sumiyama: Endoscopic pyloroplasty for adult hypertrophic pyloric stenosis associated with esophageal achalasia. In: VideoGIE : an official video journal of the American Society for Gastrointestinal Endoscopy. Volume 3, Number 1, January 2018, pp. 17-19, doi :10.1016/j.vgie.2017.09.005, PMID 29905182, PMC 5965723 (free full text).
• T. White, P. G. Jackson: Chapter 16 – Vagotomy and Pyloroplasty. In: St. R. T. Evans (Ed.): Surgical Pitfalls. Prevention and Management. 2009, pp. 167-173, doi :10.1016/B978-141602951-9.50025-6
• J. G. Randolph: Y-U advancement pyloroplasty. In: Annals of surgery. Volume 181, Number 5, May 1975, pp. 586-590, doi :10.1097/00000658-197505000-00011, PMID 1093489, PMC 1345541 (free full text).

Individual references

1. ↑ ^{a b c} Pschyrembel Online
2. ↑ ^{a b} A. Hollinger, F. Largiadèr: Therapeutic principle: pyloroplasty. In: Blum A.L., Siewert J.R. (eds.) Ulcer therapy. Interdisciplinary Gastroenterology. 1978, Springer, Berlin, Heidelberg Print ISBN 978-3-642-96457-2 Online ISBN 978-3-642-96456-5
3. ↑ Heineke
4. ↑ Heinecke 1886, as stated by Maingot,R.,In: Abdominal Operations, New York, Appleton-Century-Crofts,1961;p. 169
5. ↑ J. Mikulicz: Zur Operativen Behandlung des Stenosirenden Magenschwures. In: Arch.Klin.Chir. , vol. 37, p. 79, 1888
6. ↑ M. Bettex, N. Genton, M. Stockmann (eds.): Pediatric Surgery. Diagnosis, indication, therapy, prognosis. 2. Auflage, Thieme (1982), ISBN 3-13-338102-4.
7. ↑ V. Schumpelick: Operationsatlas Chirurgie. Georg Thieme Verlag, Stuttgart 2006, ISBN 3-13-140632-1, p. 172 (online).
8. ↑ J. M. T. Finney: A new Method of Pyloroplasty, In: Bull.Johns Hopkins Hosp.,Vol. 13, p. 155,1902.
9. ↑ M. Jaboulay: La Gastro-énterostomie, la jéjuno-duodénostomie, la résection du pylore.In: Arch.Prov.Chir.,vol.1, p. 1,1892.
10. ↑ emedicine
11. ↑ E. W. Swanson, S. J. Swanson, R. S. Swanson: Endoscopic pyloric balloon dilatation obviates the need for pyloroplasty at esophagectomy. In: Surgical endoscopy. Volume 26, Number 7, July 2012, pp. 2023-2028, doi :10.1007/s00464-012-2151-5, PMID 22398960.

Web links

• Pyloroplasty
• MedlinePlus

This article is about a health topic. It is not intended as a self-diagnosis and does not replace a diagnosis by a doctor. Please note the reference to health topics!