Abstract
Heineke in 1886 and von Mikulicz in 1887 independently described the popular method of pyloroplasty by longitudinal incision and transverse closure. In some patients, particularly children, the Heineke-Mikulicz procedure has not always been satisfactory because of inadequate size and distortion of the muscular gastroduodenal funnel. In 1958, Moschel and co-workers reintroduced the concept of the Y-V advancement principle to enlarge the pylorus. This operation has not been widely adopted but has a number of attractive features, including simplicity, safety, and maximal channel size with minimal operating time. The standard Y-V principle has been modified in favor of a broadly based U-shaped pedicle constructed from the presenting surface of the gastric antrum which is advanced into an incision made in the anterior duodenum. This operation has been used in 33 patients, who range in age from 3 weeks to 17 years. They have been variously followed from 6 months to 10 years. The surgical need for pyloroplasty in this group of patients included hiatal hernia with delayed gastric emptying (19 patients); vagotomy for ulcer (7 patients); esophageal substitution (4 patients); vagotomy for reflux esophagitis (2 patients); and, in one instance, revision of an obstructed Heineke-Mikulicz pyloroplasty. Complications have been minimal; gastric drainage has been highly satisfactory. In long-term followup, no ill effect has been seen from the presence of antral mucosa in the proximal duodenum.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Ballinger W. F., 2nd, Solanke T. F. Serosal patch pyloroplasty. Surg Gynecol Obstet. 1966 Jun;122(6):1283–1288. [PubMed] [Google Scholar]
- GAMBEE L. P. A single-layer open intestinal anastomosis applicable to the small as well as the large intestine. West J Surg Obstet Gynecol. 1951 Jan;59(1):1–5. [PubMed] [Google Scholar]
- Hurwitz A., Egozi I., Sarduy P. Gastroduodenostomy (Jaboulay procedure) and truncal vagotomy in the management of duodenal ulcer. South Med J. 1973 Nov;66(11):1244–1246. doi: 10.1097/00007611-197311000-00010. [DOI] [PubMed] [Google Scholar]
- JOHNSTON J. H. Hiatus hernia in childhood. Arch Dis Child. 1960 Feb;35:61–65. doi: 10.1136/adc.35.179.61. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Johnston P. W., Snyder W. H., Jr Vagotomy and pyloroplasty in infancy and childhood. J Pediatr Surg. 1968 Apr;3(2):238–245. doi: 10.1016/0022-3468(68)90006-7. [DOI] [PubMed] [Google Scholar]
- MOSCHEL D. M., WALSKE B. R., NEUMAYER F. A new technique for pyloroplasty. Surgery. 1958 Nov;44(5):813–816. [PubMed] [Google Scholar]
- Randolph J. G., Lilly J. R. The influence of vagotomy and pyloroplasty on the growth and survival of enterectomized yung animals. J Pediatr Surg. 1968 Apr;3(2):232–237. doi: 10.1016/0022-3468(68)90005-5. [DOI] [PubMed] [Google Scholar]
- SCHUSTER S. R., GROSS R. E. Peptic ulcer disease in childhood. Am J Surg. 1963 Mar;105:324–333. doi: 10.1016/0002-9610(63)90344-1. [DOI] [PubMed] [Google Scholar]
- WEINBERG J. A., STEMPIEN S. J., MOVIUS H. J., DAGRADI A. E. Vagotomy and pyloroplasty in the treatment of duodenal ulcer. Am J Surg. 1956 Aug;92(2):202–207. doi: 10.1016/s0002-9610(56)80060-3. [DOI] [PubMed] [Google Scholar]
- Wise L., Ballinger W. F. The elective surgical treatment of chronic duodenal ulcer: a critical review. Surgery. 1974 Nov;76(5):811–826. [PubMed] [Google Scholar]