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Pyloroplasty

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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

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.

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