Pyloric atresia: a new operation to reconstruct the pyloric sphincter

Abstract

Background/purpose: The standard method of surgical correction of pyloric atresia "solid segment" type is a gastroduodenostomy that can in the long term cause bilious duodenogastric reflux. The authors report 2 cases of pyloric atresia in which the pyloric sphincter was reconstructed by a new technique of gastroduodenal mucosal advancement anastomosis.

Methods: Two premature babies with "solid segment"-type pyloric atresia, one with an associated junctional epidermolysis bullosa, underwent surgery for reconstruction of the pyloric sphincter. By a longitudinal incision of the atretic pylorus, the cul-de-sacs of gastric and duodenal mucosa were isolated in the respective gastric and duodenal sides, advanced into the opened pyloric canal, and sutured together using end-to-end anastomosis. The longitudinal pyloromyotomy then was closed above the reconstructed mucosal pyloric neocanal.

Results: The postoperative course was normal. At 7 years (patient 1) and 2 years (patient 2) after the operation, both are well, and no gastrointestinal disorders are present. Good competence of the pyloric sphincter has been confirmed by x-ray barium meal in both cases, and by HIDA technetium 99m hepatic scintiscan and esophagogastroduodenoscopy (EGD) with biopsy in patient 1.

Conclusions: Our technique of surgical correction of pyloric atresia allows preservation of the pyloric sphincter, whose muscular layer, although hypoplastic, is present in these cases.