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Pyloric atresia: a new operation to reconstruct the pyloric sphincter
Antonio Dessanti1, Vincenzo Di Benedetto, Marco Iannuccelli
1Department of Pediatric Surgery, University of Sassari, Sassari, Italy.
Insights
A novel gastroduodenal mucosal advancement anastomosis technique effectively reconstructs the pyloric sphincter in "solid segment" type pyloric atresia, preserving its function and avoiding long-term complications like bilious reflux.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Congenital Anomalies
Background:
- Pyloric atresia, specifically the "solid segment" type, presents surgical challenges.
- Standard gastroduodenostomy for correction can lead to long-term bilious duodenogastric reflux.
Purpose of the Study:
- To report a new technique for pyloric sphincter reconstruction in "solid segment" type pyloric atresia.
- To evaluate the efficacy of gastroduodenal mucosal advancement anastomosis in preserving pyloric sphincter function.
Main Methods:
- Two neonates with "solid segment" pyloric atresia underwent surgical reconstruction.
- A longitudinal incision of the atretic pylorus allowed advancement and suturing of gastric and duodenal mucosa to create a neos-sphincter.
Main Results:
- Both patients experienced normal postoperative courses.
- At long-term follow-up (7 and 2 years), both patients remain well with no gastrointestinal disorders.
- Pyloric sphincter competence was confirmed radiologically and endoscopically.
Conclusions:
- The described gastroduodenal mucosal advancement anastomosis technique successfully reconstructs the pyloric sphincter in "solid segment" type pyloric atresia.
- This method preserves the pyloric sphincter, mitigating risks of reflux associated with traditional methods.
Background/Purpose:
The standard method of surgical correction of pyloric atresia "solid segment" type is a gastroduodenostomy that can in the long term cause bilious duodenogastric reflux. The authors report 2 cases of pyloric atresia in which the pyloric sphincter was reconstructed by a new technique of gastroduodenal mucosal advancement anastomosis.
Methods:
Two premature babies with "solid segment"-type pyloric atresia, one with an associated junctional epidermolysis bullosa, underwent surgery for reconstruction of the pyloric sphincter. By a longitudinal incision of the atretic pylorus, the cul-de-sacs of gastric and duodenal mucosa were isolated in the respective gastric and duodenal sides, advanced into the opened pyloric canal, and sutured together using end-to-end anastomosis. The longitudinal pyloromyotomy then was closed above the reconstructed mucosal pyloric neocanal.
Results:
The postoperative course was normal. At 7 years (patient 1) and 2 years (patient 2) after the operation, both are well, and no gastrointestinal disorders are present. Good competence of the pyloric sphincter has been confirmed by x-ray barium meal in both cases, and by HIDA technetium 99m hepatic scintiscan and esophagogastroduodenoscopy (EGD) with biopsy in patient 1.
Conclusions:
Our technique of surgical correction of pyloric atresia allows preservation of the pyloric sphincter, whose muscular layer, although hypoplastic, is present in these cases.
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