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Esophageal replacement with colon
Published in Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg, Operative Pediatric Surgery, 2020
Naziha Khen-Dunlop, Carmen Capito, Christophe Chardot, Yann Révillon
The proximal anastomosis between the esophagus and colon is created in the neck with a single layer of absorbable sutures and the colon is fixed to the neck muscles. The gastrocolic anastomosis is performed at the anterior gastric wall, to limit gastrocolonic reflux, and the anastomosis is partially wrapped with the stomach (Figure 10.3). Pyloroplasty is usually performed and (temporary) gastrostomy is left for gastric decompression and transition to oral feeds.
Stomach and duodenum
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
Bile vomiting can occur after any form of vagotomy with drainage or gastrectomy. Commonly, the patient presents with vomiting a mixture of food and bile or sometimes some bile alone after a meal. Often eating will precipitate abdominal pain and reflux symptoms are common. Bile chelating agents can be tried but are usually ineffective. In intractable cases, revisional surgery may be indicated. The nature of that revisional surgery depends very much on the original operation. Following gastrectomy, Roux-en-Y diversion is probably the best treatment. In patients with a gastroenterostomy, this can be taken down and, in most circumstances a small pyloroplasty can be performed. In patients with a pyloroplasty, reconstruction of the pylorus has been attempted but, in general terms, the results of this operation have been rather poor. Antrectomy and Roux-en-Y reconstruction may be the better option.
Gastro-oesophageal reflux disease
Published in Brice Antao, S Irish Michael, Anthony Lander, S Rothenberg MD Steven, Succeeding in Paediatric Surgery Examinations, 2017
Total oesophagogastric dissociation, as its name suggests, adopts another approach to the control of GOR. By completely detaching the stomach from the oesophagus and closing the stomach at the gastro-oesophageal junction, there is no possibility of GOR. Because this procedure involves complete vagotomy, a pyloroplasty is also performed. The oesophagus is reconnected to the rest of the GI tract by a Roux loop, to allow swallowing of saliva and limited foodstuffs. Enteral feeding is via gastrostomy. Initially this procedure was a salvage procedure for those with recurrent GOR following failed fundoplication. It has, however, been used as a primary procedure in children with severe neurological handicap, where the results of failure of fundoplication would be catastrophic, or the risks of failure high.
Current and future treatment management strategies for gastroparesis
Published in Expert Opinion on Orphan Drugs, 2019
Priyadarshini Loganathan, Mahesh Gajendran, Richard McCallum
Despite some improvement in symptoms with GES therapy particularly nausea, there is generally no predictable acceleration of GE. Therefore, gastric electric stimulation combined with pyloroplasty was conceived as a way to achieve a ‘curative’ result. The theory being that pyloroplasty normalizes the GE while GES functions as an antiemetic working through an afferent pathway from the site of the gastric electrode neurostimulation. A prospective cohort study in 49 patients (17 diabetic, 9 idiopathic, 23 Post-surgical) with GP showed a significant 64% improvement in GE by 4 h (p < 0.001) in patients who had GES placement + pyloroplasty [104]. A prospective single-arm trial with 27 GP patients who underwent simultaneous gastric electrical stimulator implantation with Heineke–Mikulicz pyloroplasty showed significantly accelerated GE and 70% reduction in GP symptoms [105]. This combined approach of pyloroplasty with GES placement is now regarded as the ‘Gold standard’ solution for drug refractory GP, a subgroup of at least 30% of GP patients. The major question remaining is whether pyloroplasty alone is as effective as GES + Pyloroplasty. This question is currently being addressed in double-blinded randomized trial at Texas Tech El Paso, and the answer will be available in 2019.
Adult idiopathic hypertrophic pyloric stenosis - a common presentation with an uncommon diagnosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Syed Moin Hassan, Ateeq Mubarik, Salman Muddassir, Furqan Haq
Multiple treatments have been proposed for AIHPS, including endoscopic dilation, pyloromyotomy with or without pyloroplasty, gastrectomy with a Billroth 1 gastroduodenostomy. Laparoscopic pyloroplasty is a less invasive option. Endoscopic dilation has a high rate of recurrence and provides only temporary relief of symptoms. It is an option in high-risk surgical patients. Currently, there is no evidence of one surgical technique being superior to another. Further research on AIHPS is warranted before a method can be finalized as the standard of care [10,13,21].