43800 Pyloroplasty

Name of the Procedure:

Pyloroplasty
(Common names: Pylorus surgery, Pyloric stenosis surgery)

Summary

Pyloroplasty is a surgical procedure designed to widen the pylorus, which is the opening from the stomach into the small intestine. This helps food pass more easily from the stomach to the intestine.

Purpose

Pyloroplasty addresses problems related to the narrowing of the pylorus, known as pyloric stenosis. The main goal is to alleviate symptoms like vomiting, stomach pain, and delayed stomach emptying, improving digestive function and overall comfort.

Indications

• Severe vomiting
• Difficulty with stomach emptying (gastric outlet obstruction)
• Conditions like peptic ulcer disease or congenital pyloric stenosis
• Patients who have not responded to medical therapies for pyloric stenosis

Preparation

• Patients may need to fast for 8-12 hours before the procedure.
• Adjustments to medications, particularly blood thinners or diabetes medications, might be necessary.
• Preoperative diagnostic tests might include blood work, imaging studies like an ultrasound or endoscopy, and sometimes an EKG.

Procedure Description

1. Anesthesia: General anesthesia is administered to ensure the patient is unconscious and pain-free.
2. Incision: A surgical incision is made, either through traditional open surgery or laparoscopically with several small incisions.
3. Modification: The surgeon cuts through the pylorus and then sutures it in a way that widens the channel without closing it, enhancing the passageway.
4. Closure: The incisions are closed with sutures or staples, and a dressing is applied.

Duration

The procedure typically takes about 1-2 hours.

Setting

Pyloroplasty is performed in a hospital operating room.

Personnel

• Surgeon
• Anesthesiologist
• Surgical nurses
• Possibly a gastroenterologist

Risks and Complications

• Common risks: Infection, bleeding, and reaction to anesthesia.
• Rare risks: Injury to surrounding organs, leakage from the stomach or intestine, delayed gastric emptying.
• Management: Complications are managed with medications, additional surgery if necessary, and close postoperative monitoring.

Benefits

• Relief from symptoms like vomiting, abdominal pain, and delayed stomach emptying.
• Improved ability to eat and digest food normally.
• Most patients start to experience these benefits within a week following surgery.

Recovery

• Post-procedure, the patient may need to stay in the hospital for 2-4 days for monitoring.
• Dietary restrictions may be advised, starting with liquids and gradually advancing to solid foods.
• Avoid strenuous activities for at least 2-4 weeks.
• Follow-up visits are essential to monitor healing and recovery.

Alternatives

• Endoscopic balloon dilation: A less invasive option but may require multiple treatments.
• Medications: Used to manage symptoms but may not be effective for severe cases.
• Pros and cons: Surgery provides a more permanent solution but comes with higher risks and longer recovery compared to non-surgical options.

Patient Experience

• During the procedure: The patient will be under general anesthesia and will not feel anything.
• After the procedure: Patients may experience some pain and discomfort around the surgical site, managed with pain medications.
• Full recovery may take several weeks, with improvements in symptoms noticeable within a few days to a week.