What Is the Surgical Procedure for Pyloroplasty?

Pyloroplasty is a procedure to relax the pyloric sphincter, which controls the opening from the stomach into the small intestine.

The pylorus is the lowermost part of the stomach, where it connects to the beginning of the small intestine (duodenum). Pyloroplasty is a surgical procedure to widen the pylorus by cutting and relaxing the pyloric sphincter muscle of the stomach.

The pyloric opening is controlled by the pyloric sphincter muscle, which acts as a valve. The pyloric sphincter relaxes to allow the food flow into the duodenum and contracts to prevent it from flowing back into the stomach.

Pyloroplasty may be performed using one of three techniques:

• Heineke-Mikulicz pyloroplasty: The pylorus is cut lengthwise to make it wider and then sutured across. This is the most commonly performed pyloroplasty procedure.
• Jaboulay pyloroplasty: The stomach is directly connected to the duodenum (gastroduodenostomy), but the pylorus is not incised.
• Finney pyloroplasty: A gastroduodenostomy is performed along with an incision of the pylorus. This method is rarely used.

Alternatives to pyloroplasty are:

• Chemical pyloroplasty: Botulinum toxin is injected into the pylorus making it relax.
• Pyloromyotomy: the muscle surrounding the pylorus is cut lengthwise. The pyloric tract becomes wider because it bulges through the opening in the muscle.
• Pyloric dilatation: the pylorus is dilated with a balloon passed through a flexible tube (endoscope) through the nose and upper digestive tract or through a tiny incision in the stomach wall (gastrotomy).

Pyloroplasty is performed when normal function of the pylorus is affected due to disease, or as an adjunct to certain other gastric surgeries. Pyloroplasty is most commonly performed as a gastric drainage procedure along with a vagotomy (surgical severing of the part of the vagus nerve controlling the digestive system). A vagotomy is performed as treatment for peptic ulcers.

In addition, a pyloroplasty may be performed to treat other conditions that affect the digestive system such as

• Bleeding or perforated bleeding ulcers in the duodenum.
• Abnormally narrow pylorus (pyloric stenosis)
• Obstruction in the pylorus
• Pyloric atresia (congenital condition causing pyloric stenosis)
• Helicobacter pylori infection
• Vagus nerve damage
• Delayed emptying of stomach contents (gastroparesis)
• Diabetes

A general surgeon usually performs a pyloroplasty under general anesthesia. It may be performed as an open surgery with a large incision in the abdomen or a laparoscopic surgery, which is less invasive with several smaller incisions.

Preparation

• Prior to a pyloroplasty a patient
• Undergoes blood, urine and imaging tests.
• Must avoid eating or drinking 8 hours prior to the procedure.
• Check with the doctor before taking any regular medications.
• Inform the doctor of any allergies.
• May undergo stomach pumping (gastric lavage) to clear residual gastric contents

Procedure

• An anesthesiologist administers anesthesia and monitors the patient’s vital functions during the procedure.
• The patient will be intubated to provide oxygen.
• The surgeon makes one or more incisions in the abdomen depending on the type of surgery.
• The surgeon makes a 5 cm-long incision lengthwise starting from the lower stomach (antrum), along the pylorus up to the top part of the duodenum.
• The incision is stretched into a diamond shape to widen the pylorus.
• Part or all of the pyloric sphincter muscle may be removed.
• The pyloric incision is closed with sutures.
• The abdominal muscles and the incision are sutured.

Post-procedure

• The patient is brought out of anesthesia and administered painkillers for post-surgical pain.
• The patient is monitored in the recovery room for a few hours.
• Most people will be able to go home after three to six days in the hospital, depending on the underlying conditions.
• Complete recovery may take up to six weeks, during which the patient must avoid heavy lifting and strenuous activities.

As is common with any surgical procedure, pyloroplasty carries certain risks and complications, which include:

• Anesthetic side effects such as
  • Headache
  • Nausea
  • Confusion
• Surgical risks such as
  • Wound infection
  • Hemorrhage
  • Blood clots
• Injury to nearby organs, blood vessels or nerves
• Pneumonia
• Incisional hernia

Complications of associated surgeries such as vagotomy or gastrectomy (removal of part of the stomach)

Gastric dumping syndrome due to the stomach contents emptying too fast into the intestine

Bile reflux and gastritis

Bowel blockage

Inflammation of the stomach lining (peritonitis)

Weight loss and fatigue

Infection and sepsis

Recurrence of gastric ulcers

Diarrhea and malnutrition