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PubMed1983

Individual and combined roles of the pylorus and the antrum in the canine gastric emptying of a liquid and a digestible solid.

The gastric emptying of a liquid (5% dextrose) and a digestible solid (liver) were studied in 8 dogs with an intact stomach, after pylorectomy, after antrectomy, and after distal (Billroth I) gastrectomy. Pylorectomy and particularly Billroth I gastrectomy resulted in more rapid gastric emptying of the liquid. With an intact stomach, the digestible solid was broken down predominantly (93.8%) into very small particle size (less than 0.15 mm) before being passed into the duodenum. This ability was largely preserved after both pylorectomy or antrectomy. Billroth I gastrectomy resulted in the small bowel being presented with much larger particles of a digestible solid than if the antrum or the pylorus, or both, were preserved. After excision of both the antrum and the pylorus, 38.2% of the liver emptied in particle size greater than 1 mm as opposed to 2.5% from the intact stomach, 4.9% after pylorectomy, and 6.1% after antrectomy. Thus, both the pylorus and the antrum can control the gastric emptying of both a liquid and a digestible solid.

Animals↗
PubMed1981

[Duodenogastric-reflux-favouring behaviour of the pylorus in patients with gastritis and duodenitis (author's transl)].

The pylorus was observed gastroscopically, biopsies of the gastral and duodenal mucosa were taken in 183 patients. If the mucosa did not show signs of inflammation, reflux-favouring behaviour of the pylorus (permanently being ajar or acting hyperkinetically) was rare. In patients with gastritis it was significantly more frequent. If the inflammation concerned the mucosa of the stomach as well as that of the duodenum the reflux-favouring behaviour of the pylorus was especially frequent.

Duodenal Diseases↗
PubMed1981

Double-channel pylorus: congenital or acquired.

It is difficult to decide on the best method of management for the double-channel pylorus because there is no agreement as to whether this uncommon condition is congenital or acquired. Of 60 cases reported in the literature 55 were associated with peptic ulcer disease strongly suggesting an acquired origin. A congenital origin should be accepted only if specific criteria obtain: (a) presence in early childhood, (b) presence of mucous, lamina propria and muscularis mucosae on microscopic examination and (c) characteristic findings as fluoroscopic examination. The authors report three patients with a double-channel pylorus. In one a prepyloric ulcer immediately preceded the development of the false antroduodenal channel. The other patients had peptic ulcer disease. All were treated conservatively. Operation is unnecessary except for complications that may arise. The authors' cases demonstrate that unless the diagnosis of double-channel pylorus is considered the radiologic and endoscopic findings may be misinterpreted.

Aged↗
PubMed1980

Mechanical characteristics of the cat pylorus.

In vitro force-length curves of rings from the gastroduodenal junction were obtained in standard tyrode solution, in tyrode with 140 mM KCl, and in calcium-free tyrode with 5 mM sodium EDTA, to determine basal, total, and passive forces, respectively. Active force was obtained as a difference between total and passive forces. Basal, total, passive, and active forces were higher for pyloric rings than for duodenal and antral rings. Furthermore, in the pylorus the force-length curves were shifted to the left along the length axis due to a narrowing at the gastroduodenal junction. Pressure-diameter relationships calculated from the in vitro force-length data and compared with previously determined in vivo pressure-diameter data, demonstrated good correlation between the in vivo and in vitro data. These data indicate that the higher forces and pressures observed in the pylorus are due to a combination of higher active and passive components. At low levels of stretch, the active forces are higher, while at high levels of stretch the passive forces become prevalent. These data suggest that, because of its passive properties the pylorus may act as a stricture and resist opening to large diameters, thus impeding the passage of large boluses. Near closure, however, any pressure gradient at the gastroduodenal junction would be due to active contraction of the pyloric circular muscles, and thus be susceptible to modulation through neural and/or myogenic factors.

Animals↗
PubMed1980

Achalasia of the cardiac sphincter and the pylorus?

A patient with a recurrent achalasia of the cardia was found, after a Heller cardiomyotomy, also to have pyloric insufficiency necessitating gastric resection. The pylorus appeared to contain virtually no ganglia at all. On the basis of an experiment with rabbits, in which vagotomy was shown to have no appreciable effect on the ganglion cells in the pylorus, it was concluded that the abnormality demonstrated in this patient could not be attributed to a possible injury of the vagus nerves but was probably due instead to achalasia of the pylorus.

Aged↗
PubMed1994

65 cases of preserving pylorus pancreatoduodenectomy: experience and problems.

Sixty-five patients with neoplasm (62 cases) or pancreatitis (3 cases) were treated with preserving pylorus pancreatoduodenectomy (PPPD) from 1984 to 1991. One postoperative death occurred. Follow-up studies were performed in 35 patients who had been treated by PPPD or the standard Whipple's procedure; they were questioned carefully concerning clinical symptoms. Further studies were performed in 20 patients with or without pylorus preservation (10 patients, respectively). Nutritional status and gastrointestinal digestive and absorptive functions were evaluated by determination of serum components, gastric analysis, barium emptying time, D-xylose absorption test, 14CO2 breath test, PABA, and other methods. The results demonstrated malnutrition and postgastrectomy syndromes in some patients after the standard Whipple's procedure, but not in those with PPPD. The quality of life was better in the latter. Pylorus preservation may be the main reason for this above difference. Delayed gastric emptying in the early postoperative period was a complication in some patients (21%) treated by PPPD. We recommend PPPD for pancreatoduodenectomy.

Adenocarcinoma↗
PubMedDate not supplied

Pylorus preserving pancreaticoduodenectomy.

We have performed 9 pylorus preserving pancreaticoduodenectomies (PPPD) for periampullary malignancies. In these 9 patients, six had been diagnosed as having carcinoma of the ampulla of Vater, two pancreatic carcinoma and one duodenal carcinoma. We have no operative mortality and a 44 per cent rate of morbidity. Complications include wound infections (3), pleural effusion (1), intraabdominal abscess (1), delayed gastric emptying (1). There was neither biliary nor pancreatic leakage in these patients. None of the patients had gastrointestinal haemorrhage and marginal ulceration. We have complete follow-up for all cases. Eight of 9 patients are alive, one patient who had been operated for carcinoma of ampulla of Vater died the 14th month postoperatively. During the follow-up, in 7 patients we have observed neither recurrence nor metastasis but in one patient, who is still alive, operated for carcinoma of the pancreas, recurrence in the pancreatic remnant was detected 27 months after the operation. In four months, all patients regained 90 per cent of the weight lost prior to operation. During the follow-up period no patients had gastrointestinal dumping, diarrhoea, or delayed gastric emptying. We concluded that PPPD, technically easier and faster, can therefore be performed with a much lower morbidity and mortality than the standard Whipple procedure. Preservation of the pylorus reduces the incidence of marginal ulceration, and patients undergoing PPPD are more likely to regain their preoperative weight. The antrum and pylorus were structurally preserved in the first successful radical pancreaticoduodenectomy performed by Kausch in 1912 (13) and Whipple in 1935 (28).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1977

Ultrastructural observations of the myenteric plexus of the pylorus in infantile hypertrophic pyloric stenosis.

Myenteric plexuses and smooth muscle of the pylorus obtained by biopsy at pyloro myotomy in 5 infants with hypertrophic pyloric stenosis were studied by electron microscopy. Animal controls consisted of pyloruses from 2 infant and 2 adult rabbits and 2 adult rats. The principal findings in the plexuses of the patients were moderate numbers of variably sized, swollen degenerating axons that contained dense bodies, lamellated figures, vacuoles, granular or fibrillar material, and swollen mitochondria. The significance of this alteration in the etiology and pathogenesis of this disorder is not clear. Neurons in the plexuses showed no definite abnormalities. Although these findings do not confirm previous light microscopic observation of neuronal changes in the pyloric myenteric plexuses, they do not exclude a neurogenic mechanism for this disorder. The presence of small immature neurons and large mature neurons suggests that neuronal maturation and development in infantile hypertrophic pyloric stenosis are not impaired as previously reported. No ultrastructural changes were found in interstitial cells of the myenteric plexuses. Except for hypertrophy of the circular smooth muscle layers, no specific alterations were found in muscle fibers of the pylorus.

Animals↗
PubMed1997

Biliopancreatic diversion with pylorus-preserving technique: a new method for the surgical control of hypercholesterolaemia and diabetes II?

OBJECTIVE: The aim of this study was to evaluate the efficacy of biliopancreatic diversion by Scopinaro's method, with a pylorus-preserving modification, in correcting hypercholesterolaemia and diabetes II not controllable by diet or medical treatment. DESIGN: Besides weight loss, Scopinaro's operation produces a correction of hypercholesterolaemia and diabetes. These results encouraged us to perform BPD without gastric resection, thus preserving the functions of the stomach and pylorus in moderately overweight patients with hypercholesterolaemia and diabetes. SETTING AND PATIENTS: The pylorus-preserving technique has been performed on two patients suffering from severe hypercholesterolaemia and hyperglycaemia and who were not more than 30% overweight, at Clinica Chirurgica and Chirurgia d'Urgenza Department, University of Sassari, Italy. Both patients had a six-month follow-up assessment. MAIN OUTCOME MEASURES. Examination of cholesterol and glycaemia levels after the operation, and the moderate weight loss. INTERVENTION: The operation is the same as Scopinaro's with regard to the length of intestine forming the alimentary loop and the common tract. The difference lies in the fact that instead of resecting the stomach and creating a gastroileostomy, we resect the duodenum, and perform a duodenoileostomy. RESULTS. In both patients the cholesterol and glycaemia levels had returned to normal 1 month after the operation and are stable after six months. Weight loss was only moderate. CONCLUSION: By the preliminary data on two patients treated with our modified technique this method seems to be as effective in controlling lipidic metabolism and diabetes II as the original version of biliopancreatic diversion.

Biliopancreatic Diversion↗
PubMed2003

Indications for a pylorus-preserving gastrectomy for gastric cancer with proper muscle invasion.

HYPOTHESIS: Our previous demonstrations of the feasibility of a pylorus-preserving gastrectomy with a wider-scope lymphadenectomy for early gastric cancer (GC) have raised the possibility of applying pylorus-preserving gastrectomy to a broader segment of GC patients, such as those having GC with invasion extending into the proper muscle layer (GCpm). DESIGN: Case series. SETTING: Tertiary care center. PATIENTS: This study comprised 107 patients with solitary primary GCpm located in the middle or lower third of the stomach. INTERVENTION: All patients underwent gastrectomy, using at least the former D2 dissection of the American Joint Committee on Cancer. MAIN OUTCOME MEASURES: Patterns and sites of nodal involvement were analyzed in relationship to other clinicopathologic characteristics, including preoperative and intraoperative evaluations of tumor depth (cT), nodal involvement (cN), and serosal involvement. The conditions required were serosal negativity and measurements less than or equal to cT2 cN0 with histologic proof of node negativity, or if positive, the positive nodes had to be confined to the first or selective second tier. The selective second-tier nodes were defined as those along the left gastric, common hepatic, and celiac arteries. RESULTS: The factors favoring node negativity were serosal negativity, cN0, or both. For tumors that were serosal-negative and less than or equal to cT2 cN0 to meet the above conditions, a tumor in the middle third of the stomach had to be less than or equal to 2 cm in the maximum diameter, and that in the lower third could be any size. No patients with serosal negativity and cT2 cN0 GCpm less than or equal to 2 cm in diameter died of cancer or had positive nodes beyond the selective second tier. CONCLUSIONS: Considering the required distance between the pyloric ring and distal margin of the tumor to avoid a positive resection margin, pylorus-preserving gastrectomy with a selective second-tier node dissection is optimal for tumors that are serosal negative, less than or equal to cT2 cN0, and less than or equal to 2 cm in maximum diameter when located in the middle or lower third of the stomach.

Aged↗
PubMedDate not supplied

Surgical complications of Chagas' disease: megaesophagus, achalasia of the pylorus, and cholelithiasis.

Three surgical complications of Chagas' disease--megaesophagus, achalasia of the pylorus, and cholelithiasis--were evaluated within the framework of the experience acquired in the management of 840 cases of megaesophagus--722 in the nonadvanced stage of the disease and 118 with advanced disease (dolichomegaesophagus). In the group of the 722 patients with nonadvanced disease, achalasia of the pylorus was present in 140 (19.4%), and in the total of 840 patients, uncomplicated cholelithiasis without chagasic involvement of the gallbladder and/or papilla was observed in 58 (6.9%). The 722 subjects with nonadvanced megaesophagus were submitted to wide esophagocardiomyectomy performed at the level of the anterior esophagogastric junction, combined with an antireflux valvuloplasty procedure. We recorded no mortality, and 95% excellent and good results in long-term follow-up. On the other hand, dolichomegaesophagus required esophageal resection with reconstruction by means of an esophagogastroplasty placed in the esophageal bed. The mortality rate was 4.2% (5/118); the main postoperative complications were pleural effusion (22%) and fistulas of the esophagogastric anastomosis (8.4%). Postoperatively, the patients adapted well to their new anatomy and gained weight. Achalasia of the pylorus was confirmed by delayed gastric emptying time. This entity was managed by concomitant antropyloromyectomy without mortality. Cholelithiasis was managed by cholecystectomy and radiologic exploration of the bile ducts.

Chagas Disease↗
PubMed1996

Use of the pylorus for preventing ileostomy complications. An experimental canine study.

PURPOSE: Conventional ileostomy, as it is well known, presents with persistent watery diarrhea, among other complications. The present-day modified methods of conventional ileostomy cannot effectively prevent these unpleasant consequences. The purpose of this study was to try to use the sphincter mechanism of the pylorus in ileostomy in dogs experimentally to prevent the above symptoms. METHOD: Following a highly selective vagotomy, the antrum with the pylorus and a 3-cm segment of the duodenum were separated from the gastrointestinal tract along with its vasculature and innervation, and the distal duodenal end was closed. Then, the terminal loop of ileum (before an ileostomy was performed) was dissected, and the distal segment was anastomosed with the proximal end of duodenum; the proximal segment of this loop was anastomosed with the stump of the antrum. The gastrointestinal continuity was established by anastomosis of the gastric stump to the first loop of the jejunum. RESULTS: After the procedure, the sphincter mechanism of the pylorus was preserved, and bowel movements became solid and infrequent, so a colostomy bag could be applied consistently. CONCLUSIONS: Similarity of anatomy and physiology of the alimentary tract in dogs and human favors possible application of this procedure to humans, with better results than with conventional ileostomy.

Anastomosis, Surgical↗
PubMed1992

An experimental study on the gastric acid and gut hormone secretion after pylorus preserving duodenectomy in dogs.

To clarify changes in gastric acid and gut hormone secretion after pylorus-preserving pancreaticoduodenectomy (PPPD), an experimental study was performed using a model of pylorus-preserving duodenectomy in dogs previously provided with Heidenhain pouch (HP). The duodenectomy involves resection of the duodenum and 10 cm of the proximal jejunum preserving 2 cm of juxtapyloric duodenum and round-shaped duodenal wall around pancreatic papilla. Reconstruction was done by anastomosing the rho-shaped jejunal loop to gallbladder, juxtapyloric duodenum and peripapillar round-shaped duodenal wall with ligation of the common bile duct. For these dogs, intravenous glucose tolerance test (IVGTT), oral glucose tolerance test (OGTT), meal ingestion test (TM) and histological studies of pancreatic specimen obtained at autopsy were performed investigating pancreatic, gastric acid and gut hormone secretion. Preservation of endocrine and exocrine pancreatic secretion after operation demonstrated our experimental model to be adequate for evaluation of the factor of duodenectomy in PPPD on gastric acid and gut hormone secretion avoiding the influences of changes in pancreatic secretion. Postprandial gastric acid secretion from HP did not change significantly after operation. Postprandial secretion of gastrin, glucagon, GIP and enteroglucagon did not alter significantly after operation. These results indicated that in the clinical PPPD procedure, preservation of more than 2 cm of duodenum from the pylorus produced neither postprandial gastric acid hypersecretion, which might be cause of postoperative stomal ulcer, nor any change of related gut hormone secretion.

Animals↗
PubMed1999

Pylorus-preserving pancreaticoduodenectomy versus conventional whipple operation.

During 1990 to 1997 a series of 39 patients underwent a classic pancreaticoduodenectomy and 74 a pylorus-preserving pancreaticoduodenectomy for pancreatic adenocarcinoma. The two groups had similar tumor characteristics and received comparable adjuvant treatments. No significant differences were found between the two groups in terms of mortality, morbidity, gastric emptying, food intake resumption, and hospital stay. Postoperative survival was not affected by the preservation of the pylorus, determined by both univariate and multivariate analyses. Postoperative nutritional outcome was similar in the two groups, although patients receiving adjuvant chemotherapy had a better nutritional recovery if the whole stomach was preserved. In our opinion pylorus-preserving pancreatoduodenectomy is the treatment of choice of pancreatic head cancer.

Adenocarcinoma↗
PubMed1982

Evidence for a non-classical splanchnic neural control of the feline pylorus.

Electrical stimulation of the divided splanchnic nerves proximal to the celiac ganglion in chloralosed cats induced a dilation of the pylorus in the majority of animals. However, in some cats a pure contractile motor response or a biphasic motor response (contraction followed by dilation) was elicited suggesting that the splanchnic nerves convey excitatory fibres to the pylorus as well. The pyloric and gastric contraction at such stimulation was sensitive to atropine, while the pyloric dilation was not sensitive to cholinergic, adrenergic or ganglionic blocking agents in contrast to the adrenergic gastric dilation. Since the splanchnic nerve and the pyloric wall contain numerous neuropeptides, these substances might be involved in a nonclassical neurotransmission of the splanchnic motor responses of the pylorus.

Animals↗
PubMedDate not supplied

Endoscopic findings of the gastric antrum and pylorus in horses: 162 cases (1996-2000).

Medical records and endoscopy images were examined for 209 horses that had gastroscopic examinations performed with a 2.5- or 3-m-long endoscope by one of the authors (MJM) during a 4-year period (1996-2000). The antrum and pylorus were viewed in 162 horses, and the duodenum was viewed in 94 horses. Of these 162 horses, the gastric squamous mucosa was seen in 157 horses and 50% or more of the glandular mucosa of the body of the stomach was seen in 156 horses. Erosions or ulcers were seen in the gastric squamous mucosa in 91 (58%) horses. Erosions or ulcers were seen in the glandular mucosa of the body of the stomach in only 8% of the horses. Lesions consisting of erosion or ulceration were seen in the antrum or pylorus in 94 (58%) horses. Lesions consisting of hyperemia and a rough or "bumpy" appearance were seen in the mucosa of the duodenum of 16 horses. An association between the presence of lesions in the squamous mucosa and the presence of lesions in the mucosa of the antrum/pylorus was examined by Fisher's exact test, and the linear association of lesion severity scores between the squamous mucosa and the mucosa of the antrum/pylorus was tested using a Monte Carlo estimate for linear-by-linear association. There was no association (P = .88) between these sites for presence of lesions or lesion severity scores. Similarly, there was no association between scores for the glandular mucosa in the gastric body and those in the antrum/pylorus. Because of the high prevalence of lesions in the antrum and pylorus of the stomachs of adult horses examined in a hospital setting, the entire stomach should be viewed during a gastroscopic examination.

Animals↗
PubMedDate not supplied

Pancreatoduodenectomy for pancreatic head carcinoma with or without pylorus preservation.

BACKGROUND/AIMS: With the concept of less invasive surgery, PpPD (pylorus-preserving pancreatoduodenectomy) has taken the place of conventional Whipple pancreatoduodenectomy (Whipple) as a standard operation for pancreatic head carcinoma. The aim of this paper is to compare early and late postoperative results of PpPD and Whipple for pancreatic head carcinoma. METHODOLOGY: Postoperative clinical follow-up data and outcome of 50 Japanese patients with pancreatic head carcinoma who underwent pancreatoduodenectomy with or without pylorus preservation were reviewed to scrutinize the demerits and merits of the pylorus preservation. RESULTS: Preoperative and postoperative serum chemistry was not different between the two groups. Mean operation time of the Whipple group was 517 minutes, which was significantly shorter than 624 minutes of the PpPD group (P = 0.0006). Cumulative stage was not different between the two groups. Cumulative curability of the PpPD group was superior to the Whipple group; of the 27 patients with Whipple, A in 4, B in 5 and C in 18, while of the 23 patients with PpPD, A in 12, B in 2 and C in 9 (P = 0.0182). Gastric tube was removed on POD 6.0 in the Whipple group, while on POD 39 in the PpPD group (P < 0.0001). Oral intake was started on POD 14.0 in the Whipple group, while on POD 28.3 in the PpPD group (P = 0.0018). Discharge was on POD 57.8 in the Whipple group, while POD 86.9 in the PpPD group (P = 0.0023). At the time of discharge and postoperative 6, 12, and 18 months, body weight loss from the preoperative level was 1kg smaller in the PpPD group than in the Whipple group. 1-year and 3-year survival rates of the Whipple group was 53.8% and 15.8%, while 62.8% and 19.6% of the PpPD group, showing no significant difference. CONCLUSIONS: These data show that delayed gastric emptying is evident in the PpPD group, resulting in longer hospital stay, while long-term body weight loss is smaller in this group. The clinical outcome is similar between the two groups. PpPD can be accepted as a standard operation for pancreatic head carcinoma.

Aged↗
PubMedDate not supplied

Sepsis delays gastric emptying following pylorus-preserving pancreaticoduodenectomy.

BACKGROUND/AIMS: The mechanism of delayed gastric emptying following pylorus-preserving pancreaticoduodenectomy is not completely understood. METHODOLOGY: The records of 25 patients who underwent pylorus-preserving pancreaticoduodenectomy were reviewed. Correlations of postoperative delayed gastric emptying defined as the need for postoperative nasogastric decompression for > 10 days, with perioperative parameters and clinical outcome were analyzed. RESULTS: Delayed gastric emptying occurred in 13 patients. Age, gender, presence of pancreatic carcinoma, operating time, estimated blood loss, and preservation of right gastric artery did not affect the incidence of delayed gastric emptying. Patients with pancreatic fibrosis (n = 13) had a significantly lower incidence of delayed gastric emptying than in those without fibrosis (n = 12) (23% vs. 83%, P = 0.0048). Ten patients developed postoperative septic complications, including anastomotic leakage (n = 7), pneumonia (n = 2), and severe wound infection (n = 1). The incidence of postoperative delayed gastric emptying was significantly higher in patients with septic complications than in those without septic complications (100% vs. 20%, P = 0.0001). Also, patients with intraabdominal sepsis had a significantly higher incidence of delayed gastric emptying (P = 0.0052). CONCLUSIONS: Delayed gastric emptying following pylorus-preserving pancreaticoduodenectomy is related to the presence of non-fibrotic pancreas and postoperative septic complications.

Adenocarcinoma↗