Recommended Length of Pylorus for Pyloroplasty
For pyloroplasty, the recommended length of the pyloric myotomy should extend proximally by 1-3 cm into the antrum from the pyloric ring. 1
Technical Considerations for Pyloroplasty
- The pyloric myotomy should include complete division of the pyloric ring and extend 1-3 cm proximally into the antrum 1
- A full-thickness pyloromyotomy of both circular and oblique muscle bundles should be performed while preserving the serosal layer 1
- Care must be taken not to breach the serosa to avoid injury to surrounding organs 1
- For gastric peroral endoscopic myotomy (G-POEM), the submucosal tunnel should be created starting with a bleb 4-5 cm proximal to the pylorus 1
Anatomical Considerations
- When performing pyloroplasty as part of esophageal reconstruction with gastric conduit, the procedure is an effective drainage method regardless of technique (one-layer or two-layer) 2
- For pylorus-preserving gastrectomy, the length of the retained antral segment significantly affects postoperative gastric emptying - a 2.5 cm segment proximal to the pyloric ring shows better outcomes than a 1.5 cm segment 3
- The submucosal bleb for G-POEM should be made along the greater curvature or posterior wall side 1
Procedural Variations
- For G-POEM procedures, a single myotomy is typically performed, but a double myotomy technique has shown superior results at 6-month follow-up 1
- Both pyloroplasty and pyloromyotomy are effective drainage procedures for gastric conduit used for esophageal replacement 4
- Laparoscopic and hybrid laparo-endoscopic approaches to pyloroplasty are viable alternatives to traditional open surgery 5, 6
Clinical Outcomes
- G-POEM has shown clinical success rates comparable to surgical pyloroplasty (76% vs. 77%) with less perioperative morbidity 1
- Patients with diabetic gastroparesis show the highest frequency of clinical success (89%) with pyloroplasty procedures 7
- The most common post-procedure symptoms include regurgitation, which affects approximately 30% of patients after pyloroplasty for esophageal reconstruction 2
Potential Complications and Management
- Careful attention to technique is essential to avoid breaching the serosa, which could lead to injury of surrounding organs 1
- Post-procedure monitoring should include observation for signs of leakage, with patients typically starting on clear liquids if no adverse events occur 1
- Patients with significant post-procedural abdominal pain, tachycardia, or fever should undergo CT scan or upper GI study to rule out complications 1