Pyloromyotomy: Technique and use for gastric drainage combined with vagotomy

Abstract

Abstract Gastric drainage must accompany vagotomy and for this purpose gastro-enterostomy and pyloroplasty are equally effective. When the stomach requires to be extensively mobilized, as for high oesophagogastric anastomoses, these drainage operations interfere with important collateral vessels and they may impede mobilization of the stomach by shortening or anchoring the gastric outlet. In this situation both internal pyloric stretching and stretch pyloromyotomy have, over a period of 10 years, provided effective gastric drainage. Internal pyloric stretching without myotomy would seem to be the ideal decompressive manoeuvre for cases of high gastrooesophagectomy. Pyloric stretching with or without myotomy has been used in 56 cases of transthoracic hiatus hernia repair accompanied by vagotomy for associated duodenal ulcers. The technique was used originally only because it was simpler than a pyloroplasty to perform through a left thoracotomy. On the basis of postoperative symptoms, gastric emptying times, and fasting gastric secretion volumes, it has proved as effective as other drainage procedures provided duodenal or pyloric fibrosis is absent or minimal. The technique permits of accurate hernia repair with vagotomy through a standard left thoracotomy.