CONTROLLED REOPEN SUTURE TECHNIQUE FOR PYLORIC EXCLUSION

Background: Pyloric exclusion had been widely used in the management o f complicated duodenal injuries. The original concept of pyloric exclu sion was that this technique would temporarily exclude the pylorus dur ing the healing phase, but would subsequently allow resumption of norm al gastrointestinal tract transit through the duodenum, The best metho d for pyloric exclusion has not been well established. Controversies e xist regarding the need for a gastrojejunostomy and vagotomy as part o f the procedure. None of these combinations can fulfill the original c oncept of pyloric exclusion and avoid late complications. Methods: We developed a controlled reopen suture technique for pyloric exclusion, This technique was applied to nine patients (group LT) with a complica ted blunt duodenal injury over the past 5 years. The clinical courses and outcomes of these patients were compared with an eight-patient com parison group treated by pyloric exclusion and gastrojejunostomy (grou p I) over the same time period. Results: All 17 patients survived. The re were one early (duodenal wound leakage) and two tate complications (marginal ulcers) in the group I patients. No delayed complications we re found in the group II patients. The average hospital stay was about the same in both groups. Conclusion: The controlled reopen suture tec hnique is a quick and simple procedure. In the treatment of a complica ted blunt duodenal injury, if repair of the duodenal wound will not co mpromise the lumen, gastrojejunostomy and vagotomy can be omitted when using this technique. This technique offers the best combination of l imited surgery in the severely injured patient, effective exclusion of the duodenum until after the healing has occurred, and allowance for the resumption of normal gastrointestinal tract transit through the du odenum, The late complications of gastrojejunostomy can also be avoide d.