Pyloroplasty

Your stomach partially digests food before passing it into your small intestine for further digestion. Stomach comprises three parts, namely the fundus, body, and pylorus. Pylorus is the lower, muscular channel through which food and water exit the stomach to enter the small intestine. However, certain conditions such as pyloric stenosis affect the pylorus and block this passage of food. In such cases, surgeons recommend pyloroplasty to widen the pylorus and allow the food to pass into the intestine.

Pyloroplasty is recommended in individuals with the following conditions:

• Pyloric stenosis: Symptoms of the condition include:
  • Weight loss
  • Abdominal pain
  • Dehydration
  • Episodes of forceful vomiting after feeding
• Peptic ulcer disease: Some commonly seen symptoms of peptic ulcers are:
  • Mild nausea
  • A feeling of fullness
  • Pain in the stomach that often disrupts sleep
  • A feeling of emptiness in the stomach after eating
• Gastroparesis: Some symptoms of gastroparesis are:
  • Lack of appetite
  • Heartburn
  • Upper abdominal pain
  • Bloating

This surgery may not be performed if the surgeon considers the use of general anaesthesia unsafe. This includes:

• Individuals with severe diseases of the heart, lung, or kidney
• Pregnant women
• Smokers

You will need to visit the hospital a few days prior to the surgery for a preoperative evaluation wherein you will be asked to share the following details:

• Current and past medical conditions
• Any allergies
• History of anaesthesia
• Whether you are pregnant
• List of medicines that you take, including over-the-counter medications, vitamins, and herbs

Your doctor will conduct a physical examination and will order the following tests to study your condition and ensure that you are physically fit for the surgery:

• Blood tests
• Urine tests
• Pregnancy test
• Breath tests for Helicobacter pylori (a type of bacteria) infection
• Endoscopy (a procedure wherein a thin, flexible tube fitted with a tiny camera on one end is inserted through the throat into the digestive tract)
• Imaging tests such as X-ray or computed tomography (CT) scan

In addition, you will be given the following instructions to help you prepare for the surgery:

The surgeon will share the details regarding the procedure and risks associated with the surgery. Once you understand them and agree to the surgery, you will be asked you to sign an approval form allowing the surgeon to perform the procedure.

After you arrive at the hospital, the hospital staff will provide you with a hospital gown. They will start an intravenous line in your arm or hand to supply essential medicines and fluids during the surgery. The surgery can be performed by open or laparoscopic method.

Open pyloroplasty involves the following steps:

• An anesthesiologist will administer general anaesthesia to put you into deep sleep.
• A surgeon will make a large cut (incision) on your upper abdomen to access the pylorus.
• He/she will make another incision in your pyloric muscles to widen the opening.
• Thereafter, the surgeon will stitch the cut on the muscular wall such that the widened pylorus remains open.
• Finally, the surgeon will stitch up your stomach.

Laparoscopic surgery differs from the open surgery in its approach to the pylorus and the instruments used. Instead of one large cut in the abdomen, the laparoscopic technique involves three to five small incisions on the abdomen. The surgeon will insert a laparoscope along with other small surgical tools through the cuts to operate on your pylorus. A laparoscope has a small camera that will project a video of the inside of your abdomen on a monitor inside the operating theatre. Your stomach will be inflated with gas during laparoscopic surgery to create extra room for the surgeon to work.

It takes one to two hours to complete the procedure. If the surgery is performed for an ulcer, other surgeries such as vagotomy may be performed along with pyloroplasty. After the surgery, the medical staff will take you to the recovery ward wherein you will be kept under observation for another one to two hours. When you regain consciousness, you may feel restless, groggy, or tired. You may also have a sore throat or dry mouth. These are side effects of general anaesthesia and usually fade within a few hours. You may have to stay in the hospital for about one to three days. During your hospital stay, you will gradually get back to your regular diet. Before you are discharged, the surgeon will provide you with instructions to take care of the surgical wound at home.

Once you reach home, you will need to take the following care:

• Medicine: You may experience some pain and discomfort post-surgery. The surgeon will prescribe some medications for the same. In addition, he/she will also prescribe laxatives and antibiotics. Take the medicines as directed.
• Dressing: If you are discharged with a dressing around the operated area, change it as instructed by the surgeon. Replace the dressing immediately if it gets dirty or wet.
• Shower: You will likely be allowed to shower 48 hours after surgery. However, avoid swimming or sitting in a bathtub or hot tub until the site of operation heals completely.
• Physical activity: Your doctor may suggest you to walk as often as possible. Avoid lifting heavy objects for at least six weeks following the procedure.
• Diet: You should strictly follow the dietary restrictions recommended by the surgeon. Drink plenty of water and other fluids. Eat fibre-rich foods to ease bowel movements.
• Driving: Resume driving only after consultation with the surgeon.
• Other instructions: Some general instructions to protect the abdominal incision include:
  • Hold a pillow against the incision while coughing or sneezing
  • Avoid scratching, picking, or pulling at the incision
  • Avoid wearing tight clothes around the wound

When to see the doctor?

Call or visit the surgeon at the earliest if you experience any of the following symptoms :

• Fever and chills
• Increased discharge or bleeding from the incision
• Increased discomfort, pain, swelling, or redness around the operated site
• Chest pain or cough
• Shortness of breath
• Severe abdominal pain
• Profuse sweating
• Persistent nausea or vomiting
• Blood in vomit
• If the incision starts to open
• Bloody stool

The potential risks/complications associated with the surgery are:

• Infection
• Bleeding
• Malnutrition
• Long-term diarrhoea
• Leakage of contents from the stomach
• Hernia at the site of operation
• Tear in the wall of the intestine or other nearby organs
• Risks of general anaesthesia such as confusion or lung infection

Your follow-up will be scheduled one to two weeks after the surgery wherein the surgeon will assess your healing.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.