A COMPARISON OF THE EFFICACY OF PYLOROMYOTOMY AND PYLOROPLASTY IN PATIENTS WITH GASTROESOPHAGEAL REFLUX AND DELAYED GASTRIC-EMPTYING

Purpose: Delayed gastric emptying (DGE) in children with gastroesophag eal reflux (GER) is often treated with a gastric emptying procedure. A lthough pyloroplasty is the most common gastric emptying procedure per formed, pyloromyotomy is easier to perform and is associated with less morbidity. The aim of this study was to compare the efficacy of pylor omyotomy and pyloroplasty in children with DGE and GER undergoing a fu ndoplication. Materials and Methods: We reviewed the charts of 54 pati ents with DGE who underwent pyloromyotomy (n = 29), or pyloroplasty (n = 25) along with a fundoplication. A technetium 99-labeled sulfur col loid liquid-phase gastric emptying study (GES) was performed in the pr e- and early postoperative period (within 6 months after operation). N ormal stomach emptying was defined as greater than 40% at 1 hour. Comp arisons were made with regard to postoperative complication rate, inci dence of redo fundoplication, length of postoperative hospital stay, a nd pre- and postoperative GES. Results: The pyloroplasty and pyloromyo tomy group were comparable in terms of age, sex operative indications, and neurological status. There was no significant difference in the G ES between the two groups preoperatively. There was a trend toward a d ecreased incidence of early postoperative complications including gas bloat, wound infection, pneumonia, dysphagia, bowel obstruction and du mping syndrome in the pyloromyotomy (8, 28%) when compared with the py loroplasty group (12, 48%, P=.10). The mean postoperative hospital sta y was 10.6 +/- 1.4 days for the pyloroplasty group and 7.6 +/- 1.0 day s for the pyloromyotomy group (P =.08). The incidence of a redo fundop lication was 8% in the pyloroplasty and 7% in the pyloromyotomy group. Postoperative gastric emptying increased significantly in both groups (pyloroplasty group, from 18.1 +/- 3.1 to 49.5 +/- 7.9%, P = .0005; p yloromyotomy group, from 19.3 +/- 2.1 to 41.2 +/- 3.7%, P =.0001). The re was no significant difference in the postoperative GES between the two groups (P =.289). Conclusion: Both pyloroplasty and pyloromyotomy performed in conjunction with a fundoplication resulted in a significa nt increase in early postoperative gastric emptying. There was no adva ntage of pyloroplasty over pyloromyotomy during this follow-up period. These data suggest that pyloromyotomy is an effective gastric emptyin g procedure in children with GER and DGE. Copyright (C) 1997 by W.B. S aunders Company.