Pyloric atresia: a new operation to reconstruct the pyloric sphincter.
OBJECTIVE
The standard method of surgical correction of pyloric atresia "solid segment" type is a gastroduodenostomy that can in the long term cause bilious duodenogastric reflux. The authors report 2 cases of pyloric atresia in which the pyloric sphincter was reconstructed by a new technique of gastroduodenal mucosal advancement anastomosis.


METHODS
Two premature babies with "solid segment"-type pyloric atresia, one with an associated junctional epidermolysis bullosa, underwent surgery for reconstruction of the pyloric sphincter. By a longitudinal incision of the atretic pylorus, the cul-de-sacs of gastric and duodenal mucosa were isolated in the respective gastric and duodenal sides, advanced into the opened pyloric canal, and sutured together using end-to-end anastomosis. The longitudinal pyloromyotomy then was closed above the reconstructed mucosal pyloric neocanal.


RESULTS
The postoperative course was normal. At 7 years (patient 1) and 2 years (patient 2) after the operation, both are well, and no gastrointestinal disorders are present. Good competence of the pyloric sphincter has been confirmed by x-ray barium meal in both cases, and by HIDA technetium 99m hepatic scintiscan and esophagogastroduodenoscopy (EGD) with biopsy in patient 1.


CONCLUSIONS
Our technique of surgical correction of pyloric atresia allows preservation of the pyloric sphincter, whose muscular layer, although hypoplastic, is present in these cases.
Dessanti
Antonio
A
Department of Pediatric Surgery, University of Sassari, Sassari, Italy.
Di Benedetto
Vincenzo
V
Iannuccelli
Marco
M
Balata
Antonio
A
Cossu Rocca
Paolo
P
Di Benedetto
Aurelio
A
D000714:Anastomosis, Surgical / Q000379:methods; D002648:Child; D002675:Child, Preschool; D013505:Digestive System Surgical Procedures; D016109:Epidermolysis Bullosa, Junctional / Q000150:complications; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000601:surgery*; D007409:Intestinal Atresia / Q000150:complications / Q000601:surgery*; D007413:Intestinal Mucosa / Q000601:surgery; D008297:Male; D011708:Pylorus / Q000002:abnormalities* / Q000601:surgery*; D019651:Plastic Surgery Procedures