Horseshoe incision pyloroplasty

It is suitable for extensive adhesion around duodenal ulcer, and there is a large tension in longitudinal sulcus pyloricplasty. Treatment of diseases: gastroduodenal ulcer, scar pyloric obstruction, duodenal ulcer, pyloric obstruction Indication 1. Pyloric obstruction caused by gastric cancer, the tumor has been fixed, can not be removed, can be used for gastric jejunostomy to relieve obstruction. 2. Gastric ulcer caused by pyloric obstruction, the condition is heavy, can not tolerate partial resection of the stomach, and because of such patients with low gastric acid, can be used for gastric jejunostomy. 3. Duodenal ulcer complicated with pyloric obstruction, the patient is in poor condition, can not tolerate the majority of gastric resection, can perform gastric vagus nerve cutting to reduce gastric acid, and add gastric drainage (such as pyloricplasty, stomach Duodenal anastomosis or gastrojejunostomy) to relieve retention of stomach contents. Contraindications The age of the body is weak, the vital organs such as the heart and lungs are poor, and the surgery does not restore hope. Preoperative preparation 1. Patients with pyloric obstruction, due to the retention of gastric contents, bacteria are easy to multiply, resulting in mucosal congestion and edema, which hinders the healing of postoperative anastomotic stoma. Fasting before surgery, gastric lavage before surgery, so that the stomach is drained as much as possible to reduce inflammation. 2. Appropriate fluid replacement, blood transfusion, and correction of water and electrolyte imbalance. 3. Before entering the operating room, the stomach tube should be taken out to evacuate the stomach contents to avoid vomiting during anesthesia, causing asphyxia and pulmonary complications. Surgical procedure 1. Position, incision: supine position. The median incision in the upper abdomen or the right upper rectus abdominis incision. 2. Separation of the duodenum: After laparotomy, the peritoneum (Kocher incision) is cut open on the outside of the descending part of the duodenum to separate the descending part of the duodenum to facilitate the curvature of the antrum and the duodenum. The inner edge of the lower part is close. 3. Stitching the posterior wall of the anastomosis: the inner edge of the large curvature of the stomach and the descending part of the duodenum, sutured a row of sarcoplasmic muscle sutures from the upper end. The first needle starts at the lower edge of the pylorus, and the length is 6~ 8cm, about 8 to 10 stitches. 4. Cut the gastrointestinal wall and suture the inner layer of the wall: 0.5cm from the outer layer of the posterior wall, 0.5cm shorter than the lower end of the suture, starting from the inner edge of the descending part of the duodenum (A point) From the pylorus (point B) to the stomach bend (c), make a horseshoe-shaped incision, cut the stomach, duodenum and pyloric sphincter, and sew the bleeding point. After removing the contents of the stomach and intestine, the intestines are started from the B-point on the posterior wall, and a full-thickness suture is performed first, and the ligature is not cut. Then use this line to suture the whole layer of the back wall and stitch the A and C points together. 5. Stitch the inner and outer layers of the anterior wall: continue to use the same intestine to wrap around to the anterior wall, and make a full-layer continuous varus suture to the B-point. The two-wire head is ligated and the knot is hit in the cavity. The anterior wall of the anterior wall was sutured with a silk thread. After detecting the smoothness of the anastomosis with your fingers, suture the abdominal wall by layer. complication Asphyxia and pulmonary complications.

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