RT Book, Section
A1 Hunter, John G.
A1 Spight, Donn H.
A1 Sandone, Corinne
A1 Fairman, Jennifer E.
SR Print(0)
ID 1162530413
T1 Pyloroplasty
T2 Atlas of Minimally Invasive Surgical Operations
YR 2018
FD 2018
PB McGraw-Hill Education
PP New York, NY
SN 9780071449052
LK accesssurgery.mhmedical.com/content.aspx?aid=1162530413
RD 2024/04/24
AB Laparoscopic  pyloroplasty  is  most  frequently  performed  as  an  adjunct  to  laparoscopic  Nissen  fundoplication  for  patients  with  gastroesophageal  reflux  and  delayed  gastric  emptying,  and  may  be  used  in  conjunction  with  laparoscopic  esophagectomy.  Most  frequently,  pyloroplasty  is  indicated  in  esophagectomy,  but  may  be  indicated  in  iatrogenic  gastric  emptying  disorders,  where  a  previous  operation  has  damaged  the  vagus  nerve  and  created  impaired  gastric  emptying.  Because  Nissen  fundoplication,  by  itself,  improves  gastric  emptying,  pyloroplasty  is  reserved  for  those  with  profound  emptying  disorders  manifest  by  residual  food  in  the  stomach  on  endoscopy  and/or  solid  phase  emptying  that  is  twice  the  upper  limit  of  normal  (T½  ≥  150  min).  Other  indications  for  pyloroplasty  include  gastroparesis  outside  the  setting  of  fundoplication,  or  in  a  patient  who  has  a  very  functional  Nissen  fundoplication  but  evidence  of  profound  gastroparesis.  For  patients  undergoing  laparoscopic  esophagectomy,  pyloroplasty  will  improve  gastric  conduit  emptying;  however,  it  may  accelerate  gastric  emptying  sufficiently  to  create  dumping  and  diarrhea,  and  may  increase  bile  reflux.