Introduction
Pylorus is a part of the stomach where it opens to the duodenum. A surgery done to widen this part is termed a pyloroplasty. The pylorus is a thick, muscular area. When this area becomes narrow, it becomes difficult for the food to pass through. This is the area where the stomach joins with the duodenum, the first part of the stomach. When digestion happens, the pylorus opens and closes to allow the passage of food from the stomach to the small intestine.
What Is Pyloroplasty?
A pyloroplasty is a surgery done to widen the pylorus (a part of the stomach where it opens to the duodenum). The pylorus holds the food in the stomach for digestion and sends it to the duodenum for further breakdown and absorption. When the pylorus is not functioning as it should be, the emptying of the stomach is delayed. This can cause constipation and indigestion. Sometimes pyloroplasty is done to reconstruct the pylorus damaged or altered due to some other procedure.
What Are the Indications for a Pyloroplasty?
The conditions that might require a pyloroplasty include;
- Peptic Ulcer Disease: At times, severe cases of a peptic ulcer might require surgery as its treatment. If the bleeding persists and the ulcers do not heal, a surgery called vagotomy might be suggested. A vagotomy is a surgical procedure to cut off a part of the nerve supply to reduce acid secretion. This can reduce acid secretion, but it can also affect the pylorus. An elective vagotomy usually has a pyloroplasty along with it. In such cases, the pylorus is left permanently open to allow the passage of food. Ulcers that are swollen or open and causing bleeding require surgery. If the ulcer is in the duodenum, there are chances that the pylorus is cut open for better access. A pyloroplasty might be required after this as well.
- Gastroparesis: A condition where the emptying of the stomach to the intestines is delayed is called gastroparesis. It can be due to partial paralysis of the muscles in the stomach, including the pylorus. If other treatments are not helpful, a pyloroplasty would be required to open the pyloric muscle.
- Pyloric Stenosis: It is also called infantile hyperplastic pyloric stenosis. This condition is usually seen in newborn, and rarely among adults. The condition is characterized by the thickening of the walls of the pylorus, causing it to become narrow and often blocking the outlet. Babies born with this condition might require a pyloroplasty to be able to feed without vomiting.
- Gastroesophageal Resection: Some surgeries of the stomach and intestines might cut off the vagus nerve, which may affect the ability of the pylorus muscle to open and close. Pyloroplasty might be required in this condition as well.
- Cancer: Pyloroplasty is usually done as a drainage procedure especially after gastrectomy in esophageal cancer.
- Pyloric Atresia: A condition where the pylorus is closed or is absent by birth is called pyloric atresia. Pyloroplasty is required to rectify the condition.
- Parkinson’s Disease: Pyloroplasty can be done as a solution to gastroparesis (slowed down in the gastric movements) in Parkinson’s disease.
- Multiple Sclerosis: Pyloroplasty is done in multiple sclerosis to solve gastroparesis, which can occur as the nerves become weak as a result of multiple sclerosis.
How Is Pyloroplasty Done?
There are two approaches for pyloroplasty; open surgery and laparoscopic. Laparoscopy is a minimally invasive procedure that uses lesser and smaller incisions. Both procedures are done under general anesthesia. There are different types of pyloroplasty used for different conditions.
- Heineke-Mikulicz Pyroplasty: This is the most common type of pyloroplasty. The pylorus is cut through lengthwise, including through the pyloric sphincter. It is then stitched back cross-sectionally, increasing its diameter, and relaxing the pyloric sphincter.
- Pyloromyotomy (Ramstedt Pyloroplasty): This is the treatment of choice for infants with pyloric stenosis. At times, it can be used as an alternative to Heineke’s Mikulicz pyloroplasty in adults with gastroparesis or gastric outlet obstruction. The outer layers of the pylorus are cut through, leaving behind the inner layers intact. As a result, the inner layers bulge out, increasing the diameter of the pylorus.
- Pyloric Dilatation: This is an upper endoscopic procedure where an endoscope is put through the mouth to the pylorus. The pylorus is expanded using a tool without making any incisions.
- Jaboulay/Finney Pyloroplasty: These are two uncommon pyloroplasty procedures. The pylorus is bypassed, and a new connection is made between the stomach and the duodenum. This is usually done when there is inflammation or scarring tissue in the pylorus that is beyond repair. In the Jaboulay procedure, the pylorus is bypassed completely, while in Finney’s procedure, the pylorus is cut into, creating a new connection.
After the surgery, the recovery depends on the type of procedure done. Laparoscopic procedures usually require a lesser stay in the hospital, while open surgery might take three to four days to stay in the hospital. Solid food might not be started immediately after the surgery till the wounds are healed; feeding is usually through a nasogastric tube or directly to the veins. Most people would be able to return back to normal routines and diets within a few weeks. The pyloroplasty procedure is usually successful, with a success rate of ninety percent.
What Are the Benefits of Pyloroplasty?
- Simple and minimally invasive procedure.
- Fast recovery time.
- Relieve difficulties with the digestive system.
What Are the Risks Associated With Pyloroplasty?
Pyloroplasty involves the same risks as any abdominal surgery including;
- Bleeding.
- Infection.
- Blood clot.
- Accidental injury to nearby organs.
- Leakage from the repair.
- Dumping Syndrome: This is a temporary yet common risk associated with stomach surgeries. In this condition, the contents from the stomach are emptied very fast to the small intestine. There are two phases of dumping syndrome, an early phase and a late phase. The early phase occurs shortly after eating food and involves abdominal cramps, nausea, and diarrhea. The late phase occurs a few hours after a meal and involves a rapid drop in blood sugar, causing fainting, dizziness, flushing, and heart palpitations.
- Bile Reflux: Bile reflux occurs when the pyloric sphincter does not close in time. The contents of the small intestine can have adverse effects on the stomach lining, and frequent bile reflux can cause gastritis and erosion of the lining.
Conclusion
Pyloroplasty is a surgical procedure to widen the opening between the stomach and the small intestine. Surgeons perform this procedure when the pylorus fails to function properly or is damaged due to an injury or prior surgery. When the pylorus does not work correctly, the stomach's emptying is delayed. Pyloroplasty has a high success rate, with approximately 90 % of patients experiencing positive outcomes.
