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Surgical Management: Pyloroplasty

  • Benjamin R. VeenstraEmail author
  • Minh B. Luu
Chapter

Abstract

In patients with gastroparesis, whether diabetic, idiopathic, or postsurgical, pyloroplasty remains an excellent treatment modality. Pyloroplasty allows for effective treatment without precluding future treatment modalities such as gastric stimulator implantation and gastrectomy. The authors’ preference is to perform the procedure laparoscopically in a Heineke-Mikulicz fashion, using 2–0 absorbable suture. It is our practice to confirm an airtight closure at the end of the operation, using upper endoscopy to confirm. While suture line leak is the most worrisome complication of laparoscopic pyloroplasty, the incidence of this is low. The literature supports an overall low morbidity, in addition to subjective improvement in symptoms. Recent studies have demonstrated significant decreases in the T1/2 on postoperative gastric emptying scintigraphy. Laparoscopic pyloroplasty provides a safe and effective treatment modality for gastroparesis.

Keywords

Laparoscopic Gastroparesis Pyloroplasty Stomach Heineke-Mikulicz 

References

  1. 1.
    Shada AL, Dunst CM, Pescarus R, Speer EA, Cassera M, Reavis KM, Swanstrom LL. Laparoscopic pyloroplasty is a safe and effective first-line surgical therapy for refractory gastroparesis. Surg Endosc. 2016 Apr;30(4):1326–32.CrossRefGoogle Scholar
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    Toro JP, Lytle NW, Patel AD, Davis SS Jr, Christie JA, Waring JP, Sweeney JF, Lin E. Efficacy of laparoscopic pyloroplasty for the treatment of gastroparesis. J Am Coll Surg. 2014 Apr;218(4):652–60.CrossRefGoogle Scholar
  3. 3.
    Hibbard ML, Dunst CM, Swanström LL. Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg. 2011 Sep;15(9):1513–9.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Department of Surgery, Division of MIS and BariatricsRush University Medical CenterChicagoUSA
  2. 2.Departments of General and Upper GI SurgeryRush University Medical CenterChicagoUSA

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