RT Book, Section
A1 Ellison, E. Christopher
A1 Zollinger, Robert M.
SR Print(0)
ID 1127271909
T1 PYLOROPLASTY—GASTRODUODENOSTOMY
T2 Zollinger's Atlas of Surgical Operations, 10e
YR 2016
FD 2016
PB McGraw-Hill Education
PP New York, NY
SN 978-0-07-179755-9
LK accesssurgery.mhmedical.com/content.aspx?aid=1127271909
RD 2024/04/19
AB These  procedures  may  be  used  when  the  vagus  innervation  of  the  stomach  has  been  interrupted  either  by  truncal  vagotomy,  selective  vagotomy,  or  division  of  the  vagus  nerves  associated  with  esophagogastric  resection  and  re-establishment  of  esophagogastric  continuity.  The  pyloroplasty  ensures  drainage  of  the  gastric  antrum  following  vagotomy  and,  therefore,  partially  eliminates  the  antral  phase  of  gastric  secretion.  It  does  not  alter  the  continuity  of  the  gastrointestinal  tract  and  decreases  the  possibility  of  marginal  ulceration  occasionally  seen  after  gastrojejunostomy.  Pyloroplasty  carries  a  low  surgical  morbidity  and  mortality  rate  because  of  its  technical  simplicity.  Two  types  of  pyloroplasty  are  commonly  used:  the  Heineke–Mikulicz  pyloroplasty  (figure  a)  and  the  Finney  pyloroplasty  (figure  b).  Pyloroplasty  should  be  avoided  in  the  presence  of  a  marked  inflammatory  reaction  or  severe  scarring  and  deformity  on  the  duodenal  side  of  the  gastric  outlet.  Under  these  circumstances,  the  Jaboulay  procedure  (figure  c)  should  be  considered  or  a  gastroenterostomy  located  within  3  cm  of  the  pylorus  on  the  greater  curvature.  Gastrin  levels  should  be  determined.  The  Jaboulay  reconstruction  should  be  considered  when  a  long  incision  is  made  in  the  anterior  wall  of  the  duodenum  during  the  search  for  very  small  mucosal  gastrinomas.