pyloroplasty

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Pyloroplasty

 

Definition

Pyloroplasty is an elective surgical procedure in which the lower portion of the stomach, the pylorus, is cut and resutured, to relax the muscle and widen the opening into the intestine. Pyloroplasty is a treatment for high-risk patients for gastric or peptic ulcer disease. A peptic ulcer is a well-defined sore on the stomach where the lining of the stomach or duodenum has been eaten away by stomach acid and digestive juices.

Purpose

The end of the pylorus is surrounded by a strong band of muscle (pyloric sphincter), through which stomach contents are emptied into the duodenum (the first part of the small intestine). Pyloroplasty widens this opening into the duodenum.
A pyloroplasty is performed to treat complications of gastric ulcer disease, or when conservative treatment is unsatisfactory. The longitudinal cut made in the pylorus is closed transversely, permitting the muscle to relax. By establishing an enlarged outlet from the stomach into the intestine, the stomach empties more quickly. A pyloroplasty is often done is conjunction with a vagotomy, a procedure in which the nerves that stimulate stomach acid production and gastric motility (movement) are cut. As these nerves are cut, gastric emptying may be delayed, and the pyloroplasty compensates for that effect.

Preparation

As with any surgical procedure, the patient will be required to sign a consent form after the procedure is explained thoroughly. Blood and urine studies, along with various x rays may be ordered as the doctor deems necessary. Food and fluids will be prohibited after midnight before the procedure. Cleansing enemas may be ordered to empty the intestine. If nausea or vomiting are present, a suction tube to empty the stomach may be used.

Aftercare

Post-operative care for the patient who has had a pyloroplasty, as for those who have had any major surgery, involves monitoring of blood pressure, pulse, respiration, and temperature. Breathing tends to be shallow because of the effect of anesthesia and the patient's reluctance to breathe deeply and experience pain that is caused by the abdominal incision. The patient is shown how to support the operative site while breathing deeply and coughing, and given pain medication as necessary. Fluid intake and output is measured, and the operative site is observed for color and wound drainage. Fluids are given intravenously for 24-48 hours, until the patient's diet is gradually advanced as bowel activity resumes. The patient is generally allowed to walk approximately eight hours after surgery and the average hospital stay, dependent upon overall recovery status, ranges from six to eight days.

Risks

Potential complications of this abdominal surgery include:
  • excessive bleeding
  • surgical wound infection
  • incisional hernia
  • recurrence of gastric ulcer
  • chronic diarrhea
  • malnutrition

Normal results

Complete healing is expected without complications. Four to six weeks should be allowed for recovery from the surgery.

Abnormal results

The doctor should be made aware of any of the following problems after surgery:
  • increased pain, swelling, redness, drainage, or bleeding in the surgical area
  • headache, muscle aches, dizziness, or fever
  • increased abdominal pain or swelling, constipation, nausea or vomiting, rectal bleeding, or black, tarry stools

Resources

Other

"Peptic ulcer surgery." ThriveOnline. April 20, 1988. http://thriveonline.oxygen.com.

Key terms

Gastric (or peptic) ulcer — An ulcer (sore) of the stomach, duodenum or other part of the gastrointestinal system. Though the causes are not fully understood, they include excessive secretion of gastric acid, stress, heredity, and the use of certain drugs, especially acetylsalicylic acid and nonsteroidal antiinflammatory drugs.
Pylorus — The valve which releases food from the stomach into the intestines.
Vagotomy — Cutting of the vagus nerve. If the vagus nerves are cut as they enter the stomach (truncal vagotomy), gastric secretions are decreased, as is intestinal motility (movement) and stomach emptying. In a selective vagotomy, only those branches of the vagus nerve are cut that stimulate the secretory cells.

pyloroplasty

 [pi-lor´o-plas″te]
plastic surgery of the pylorus, especially for pyloric stricture, to provide a larger communication between the stomach and duodenum.
Finney pyloroplasty enlargement of the pyloric canal by establishment of an inverted U-shaped anastomosis between the stomach and duodenum after longitudinal incision.
Heineke-Mikulicz pyloroplasty enlargement of a pyloric stricture by incising the pylorus longitudinally and suturing the incision transversely.

py·lo·ro·plas·ty

(pī-lō'rō-plas'tē),
Widening of the pyloric canal and any adjacent duodenal stricture by means of a longitudinal incision closed transversely.
[pyloro- + G. plastos, formed]

pyloroplasty

/py·lo·ro·plas·ty/ (pi-lor´ah-plas″te) plastic surgery of the pylorus.
double pyloroplasty  posterior pyloromyotomy combined with the Heineke-Mikulicz pyloroplasty.
Finney pyloroplasty  enlargement of the pyloric canal by establishment of an inverted U-shaped anastomosis between the stomach and duodenum after longitudinal incision.
Heineke-Mikulicz pyloroplasty  enlargement of a pyloric stricture by incising the pylorus longitudinally and suturing the incision transversely.

pyloroplasty

(pī-lôr′ə-plăs′tē)
n.
The surgical widening of the pyloric canal to facilitate emptying of gastric contents into the duodenum.

pyloroplasty

[pīlôr′əplas′tē]
Etymology: Gk, pyle + ouros + plassein, to mold
a surgical procedure performed to relieve pyloric stenosis by widening the pyloric outlet. Before surgery any electrolyte imbalances or fluid deficiencies are corrected; sodium chloride and potassium chloride solutions may be given to correct ion losses from vomiting, which is characteristic of pyloric stenosis. With the patient under anesthesia the pyloric opening is dilated. Diarrhea is a common postoperative complication.
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Pyloroplasty

pyloroplasty

Pyloric stenosis repair, pyloromyotomy General surgery An elective procedure in which pyloric sphincter muscle near the serosa surface is cut longitudinally and resutured, relaxing muscle and widening the outlet to the duodenum, usually accompanied by vagotomy Indications Pts with gastric or peptic ulcer disease for whom conservative management has failed. See Peptic ulcer, Vagotomy Pediatric surgery An incision on the serosa of the pylorus in an infant with pyloric stenosis, which is associated with projectile vomiting of non-bile-tinged goo; pyloroplasty is the only effective and efficient treatment for pyloric stenosis. See Pyloric stenosis.

py·lo·ro·plas·ty

(pī-lōr'ŏ-plas-tē)
Widening of the pyloric canal and any adjacent duodenal stricture by means of a longitudinal incision closed transversely.
[pyloro- + G. plastos, formed]

pyloroplasty

An operation to widen the PYLORUS so as to allow free passage of food from the STOMACH into the intestine.

pyloroplasty

plastic surgery of the pylorus, especially for pyloric stricture, to provide a larger communication between the stomach and duodenum.

Finney pyloroplasty
enlargement of the pyloric canal by establishment of an inverted U-shaped anastomosis between the stomach and duodenum after longitudinal incision.
Fredet-Ramstedt pyloroplasty
Heineke-Mikulicz pyloroplasty
enlargement of a pyloric stricture by incising the pylorus longitudinally and suturing the incision transversely.
Y-U antral advancement flap pyloroplasty
an antral flap is created and advanced over the incision through the pylorus.