Pyloroplasty

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 way 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.