Pyloroplasty

What is pyloroplasty?

Pyloroplasty is surgery that alters your pylorus, the muscular valve at the bottom of your stomach. During digestion, your pylorus opens and closes to let food pass from your stomach into your small intestine. You may need pyloroplasty surgery to open up your pylorus if something is making it difficult for food to pass through. Sometimes pyloroplasty reconstructs your pylorus if another procedure has altered or damaged it.

Why and when is pyloroplasty used?

If your pylorus isn’t working right, or if you’re having trouble with gastric emptying, pyloroplasty can help. Some conditions that may require pyloroplasty include:

Peptic ulcer disease

Some severe cases of peptic ulcer disease are treated with elective surgery. If you have repeat episodes of bleeding ulcers or ulcers that won’t heal, your healthcare provider may suggest a vagotomy. A vagotomy is a surgical procedure that cuts some of the nerve supply to your stomach to reduce stomach acid. This can help reduce ulcers, but it also disables the nerve that tells your pylorus to open and close. If you have an elective vagotomy, you will need pyloroplasty with it. In this case, the pyloroplasty opens your pylorus permanently so that food can continue to pass through.

Sometimes ulcers require emergency surgery. An ulcer that is swollen or built up with scar tissue may block the opening through your pylorus. An ulcer that is actively bleeding or has eaten a hole through your gastrointestinal wall may need surgery to repair it. If the ulcer is in your duodenum — the top part of your small intestine after your pylorus — your surgeon may need to cut into your pylorus to access it. After that, you may need pyloroplasty to reconstruct your pylorus.

Gastroparesis

Gastroparesis is partial paralysis of your stomach muscles, including your pylorus. It affects your gastric motility, the movement of food through your stomach, and results in delayed gastric emptying. Severe cases cause chronic nausea and vomiting and can prevent you from eating. If other treatments don’t help, your healthcare provider may suggest pyloroplasty to open up your pylorus.

Pyloric stenosis

Pyloric stenosis typically affects newborns, and rarely adults. It causes the walls of their pylorus to thicken, narrowing and blocking the outlet. Newborns with pyloric stenosis need pyloroplasty to be able to feed without vomiting.

Gastroesophageal resection

Surgery in your esophagus or in your stomach may cut the vagus nerve that triggers your pylorus to open and close. You may need pyloroplasty as an adjunct procedure to open your pylorus.

How is pyloroplasty performed?

Pyloroplasty can be performed through open or laparoscopic surgery. Laparoscopic surgery is a minimally invasive method that uses smaller incisions than open surgery. Both types of surgery are done under general anesthesia. That means you’ll be asleep for the procedure and won’t feel anything.

What happens during the procedure?

There are several types of pyloroplasty procedures that are used in different situations.

• Heineke-Mikulicz pyloroplasty. The Heineke-Mikulicz method is the most common type of pyloroplasty performed. The surgeon cuts lengthwise through your pylorus, including the ring of muscle that opens and closes it (the pyloric sphincter). Then they sew it back together with crosswise stitches, widening the diameter and relaxing the muscle.
• Pyloromyotomy (Ramstedt pyloroplasty). This modified pyloroplasty is the treatment of choice for infants with pyloric stenosis. Sometimes it may substitute for the Heineke-Mikulicz method in adults with gastroparesis or gastric outlet obstruction. Your surgeon cuts through some but not all layers of the pylorus, leaving the inner lining (the mucosa) intact. The mucosa bulges through the incision, creating more space inside the pylorus.
• Pyloric dilation. This operation involves an upper endoscopy, where the endoscopist (a doctor who specializes in scope procedures) uses a scope through your mouth and then inserts a tool to dilate (expand) your pylorus without cutting it.
• Jaboulay/Finney pyloroplasty. Jaboulay and Finney pyloroplasties are uncommon. They both involve bypassing your pylorus and creating a new connection between your stomach and your duodenum (gastroduodenostomy). They may be necessary if there is too much inflammation or scar tissue in your pylorus to effectively operate on it. The Jaboulay bypasses it completely, while the Finney version cuts into the pylorus while creating the new outlet.

What happens after the procedure?

After opening up your gastric outlet, your surgeon will close all of your incisions and complete the surgery. If you had laparoscopic surgery, you may be able to go home the same day. If you had open abdominal surgery, you will have a larger wound and may need to remain in the hospital for a few days. You won’t be able to eat solid food right away and may be fed through a tube or through your vein.

What are the advantages of pyloroplasty?

Pyloroplasty is usually a simple and minimally invasive procedure. It has a relatively fast recovery time and can relieve difficulties in your digestive system you’ve had for a long time as well as emergencies.

What are the complications of pyloroplasty?

General risks

Pyloroplasty shares the same general risks as any abdominal surgery, including:

• Bleeding.
• Infection.
• Blood clots.
• Injury to nearby organs.
• Leakage from the repair.

These risks are low.

Dumping syndrome

Pyloroplasty also comes with the specific risk of dumping syndrome. This is a relatively common side effect of surgery on your stomach, though it’s usually temporary. Dumping syndrome causes your stomach to dump its contents too quickly into your small intestine. It’s the opposite problem of delayed gastric emptying, which might have been the reason you had pyloroplasty.

Dumping syndrome has two phases, each with its own set of symptoms. You may experience one or both phases. Early dumping syndrome occurs shortly after you’ve finished eating and can cause nausea, stomach cramps and diarrhea. Late dumping syndrome occurs a few hours after you’ve eaten when your blood sugar rapidly drops, causing symptoms like weakness or faintness, flushing and heart palpitations.

Up to 40% of people may experience some mild symptoms of dumping syndrome after pyloroplasty. Up to 10% may have more severe symptoms. They usually go away over time. In the meantime, you can often manage the symptoms with dietary changes. Your healthcare provider will talk to you about steps you can take to avoid or manage dumping syndrome. If necessary, they can prescribe medication for it.

Bile reflux

Surgery that alters your pyloric valve can have the adverse effect of causing the contents of your small intestine to backwash into your stomach. This can happen if your pyloric valve doesn’t close properly anymore. The contents of your small intestine include bile, which can be hard on your stomach lining if it refluxes into your stomach. Too much bile reflux can cause inflammation (gastritis) or erosion.

What is recovery like from pyloroplasty?

Most people recover quickly from pyloroplasty, especially if they have laparoscopic surgery. Most are able to resume their normal activities and diet within a few weeks. If you do experience dumping syndrome, you may have to adjust the way you eat to manage those symptoms for as long as they last. This may be a few months.

How successful is pyloroplasty surgery?

As a solution for gastroparesis and gastric outlet obstruction, pyloroplasty surgery has excellent results, with reported success rates of close to 90%. When pyloroplasty is done as part of another procedure treating another problem, it effectively prevents pyloric obstruction.

A note from Cleveland Clinic

A faulty pylorus can jam up your whole digestive process. If food can’t pass through your digestive tract, nothing else can work very well for very long. Pyloroplasty is a small procedure on a small part of your stomach that can have a big impact on your health. There may be alternative treatments you can try before resorting to surgery for your condition. But if these haven’t worked for you, surgery may do the trick. This surgery has been shown to be safe and effective.