Pyloric atresia: an attempt at anatomic pyloric sphincter reconstruction.
BACKGROUND
The standard method of surgical correction of pyloric atresia is gastro-duodenostomy. The authors report a case of pyloric atresia associated with junctional epidermolysis bullosa, treated with a new technique of pyloric sphincter reconstruction by gastric and duodenal mucosa cul-de-sacs advancement and end-to-end anastomosis.


METHODS
The patient was a premature 2,100-g baby girl. X-ray showed gastric dilatation suggesting a congenital gastric obstruction. At surgery a pyloric atresia was found, with the appearance of a well-vascularized solid cord about 1.5 cm long. By longitudinal pyloromyotomy the cul-de-sacs of gastric and duodenal mucosa were reached and then isolated in the respective gastric and duodenal sides to obtain better mobilization. The mucosal cul-de-sacs, thus mobilized, were advanced easily into the pyloric canal, opened longitudinally, and were sutured together using end-to-end anastomosis. The longitudinal pyloromyotomy then was closed diagonally above the reconstructed pyloric neocanal.


RESULTS
The postoperative course was uneventful: oral feeding was started on the 11th postoperative day. At 4 year follow-up the child was well; no gastrointestinal disorders were present, confirmed by x-ray barium meal and by HIDA technetium Tc 99m hepatic scintiscan, which excluded any bilious duodeno-gastric reflux.


CONCLUSIONS
This technique of pyloric sphincter reconstruction allows preservation of the pyloric sphincter, whose sphincter muscular layer, although hypoplastic, is present in cases of pyloric atresia.
Dessanti
A
A
Institute of Clinica Chirurgica-Unit of Pediatric Surgery, University of Sassari, Italy.
Iannuccelli
M
M
Dore
A
A
Meloni
G B
GB
Niolu
P
P
D000714:Anastomosis, Surgical / Q000379:methods; D001655:Bile Reflux / Q000209:etiology; D016109:Epidermolysis Bullosa, Junctional / Q000150:complications; D005260:Female; D017219:Gastric Outlet Obstruction / Q000150:complications / Q000151:congenital* / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D011708:Pylorus / Q000002:abnormalities* / Q000601:surgery; D019651:Plastic Surgery Procedures / Q000379:methods*