What is pyloroplasty?
Pyloroplasty is surgery to widen the pylorus. This is an opening near the end of the stomach that allows food to flow into the duodenum, the first part of the small intestine.
The pylorus is surrounded by a pyloric sphincter, a thick band of smooth muscle that causes it to open and close at certain stages of digestion. The pylorus normally narrows to about 1 inch in diameter. When the pyloric opening is unusually narrow or blocked, it’s hard for food to pass through. This leads to symptoms like indigestion and constipation.
Pyloroplasty involves cutting through and removing some of the pyloric sphincter to widen and relax the pylorus. This makes it easier for food to pass into the duodenum. In some cases, the pyloric sphincter is entirely removed.
Why is it done?
In addition to widening an especially narrow pylorus, pyloroplasty can also help treat several conditions that impact the stomach and gastrointestinal nerves, such as:
- pyloric stenosis, an abnormal narrowing of the pylorus
- pyloric atresia, a closed or missing at birth pylorus
- peptic ulcers (open sores) and peptic ulcer disease (PUD)
- Parkinson’s disease
- multiple sclerosis
- gastroparesis, or delayed stomach emptying
- vagus nerve damage or disease
Depending on the condition, pyloroplasty might be done at the same time as another procedure, such as:
- Vagotomy. This procedure involves removing certain branches of the vagus nerve, which controls the gastrointestinal organs.
- Gastroduodenostomy. This procedure creates a new connection between the stomach and the duodenum.
How is it done?
Pyloroplasty can be performed as a traditional open surgery. However, many doctors now offer laparoscopic options. These are minimally invasive and carry fewer risks. Both types of surgery are usually done under general anesthesia. This means you’ll be asleep and won’t feel any pain during the surgery.
During an open pyloroplasty, surgeons will generally:
- Make a long incision or cut, usually down the middle of the abdominal wall, and use surgical tools to widen the opening.
- Make several small cuts through the muscle of the pylorus sphincter muscles, widening the pyloric opening.
- Stitch the pyloric muscles back together from bottom to top.
- Perform additional surgical procedures, such as gastroduodenostomy and vagotomy.
- In cases involving severe malnutrition, a gastro-jejunal tube, a type of feeding tube, may be inserted to allow liquid food to pass through the abdomen directly into the stomach.
In laparoscopic procedures, surgeons perform the surgery through a few small cuts. They use very small tools and a laparoscope to help guide them. A laparoscope is a long, plastic tube with a tiny, lighted video camera on one end. It’s connected to a display monitor that allows the surgeon to see what they’re doing inside your body.
During laparoscopic pyloroplasty, surgeons will generally:
- Make three to five small cuts in the stomach and insert a laparoscope.
- Pump gas into the stomach cavity to make it easier to see the full organ.
- Follow steps 2 through 5 of an open pyloroplasty, using smaller surgical tools made specifically for laparoscopic surgery.
What’s the recovery like?
Recovering from pyloroplasty is fairly quick. Most people can begin to gently move or walk within 12 hours after the surgery. Many go home after about three days of medical monitoring and care. More complex pyloroplasty surgeries may require an extra few days in the hospital.
While you recover, you may need to eat a restricted diet for a few weeks or months, depending on how extensive the surgery was and any underlying medical conditions you have. Keep in mind that it can take three months or more to start seeing the full benefits of pyloroplasty.
Most people can resume non-strenuous exercise about four to six weeks following the procedure.
Are there any risks?
All surgeries carry general risks. Some of the common complications associated with abdominal surgery include:
- stomach or intestinal damage
- allergic reaction to anesthesia medications
- internal bleeding
- blood clots
Pyloroplasty can also cause a condition called rapid gastric emptying, or stomach dumping. This involves the contents of your stomach emptying into your small intestine too quickly.
When stomach dumping happens, foods aren’t properly digested when they reach the intestines. This forces your organs to produce more digestive secretions than usual. An enlarged pylorus may also allow intestinal digestive fluids or bile to leak into the stomach. This can cause gastroenteritis. Over time, it can also lead to malnutrition in severe cases.
Symptoms of stomach dumping often begin within 30 minutes to an hour after eating. Common symptoms include:
- abdominal cramps
- vomiting, often a greenish-yellow, bitter-tasting fluid
- rapid heart rate
After a few hours, especially after eating sugary foods, the primary symptom of stomach dumping becomes low blood sugar. It occurs as a result of your body releasing a large amount of insulin to digest the increased amount of sugar in the small intestine.
Symptoms of late stomach dumping include:
- rapid heart rate
- general weakness
- intense, often painful, hunger
The bottom line
Pyloroplasty is a type of surgery that widens the opening at the bottom of the stomach. It’s often used to treat gastrointestinal conditions that haven’t responded to other treatments.
It can be done using either traditional open surgery methods or laparoscopic techniques. Following the procedure, you should be able to go home within a few days. It may be several months before you start to notice results.