Pyloric atresia: An attempt at anatomic pyloric sphincter reconstruction

Background: The standard method of surgical correction of pyloric atresia i s gastro-duodenostomy. The authors report a case of pyloric atresia associa ted with junctional epidermolysis bullosa, treated with a new technique of pyloric sphincter reconstruction by gastric and duodenal mucosa cul-de-sacs advancement and end-to-end anastomosis. Methods: The patient was a premature 2,100-g baby girl. X-ray showed gastri c dilatation suggesting a congenital gastric obstruction. At surgery a pylo ric atresia was found, with the appearance of a well-vascularized solid cor d about 1.5 cm long, By longitudinal pyloromyotomy the cul-de-sacs of gastr ic and duodenal mucosa were reached and then isolated in the respective gas tric and duodenal sides to obtain better mobilization. The mucosal cul-de-s acs, thus mobilized, were advanced easily into the pyloric canal, opened lo ngitudinally, and were sutured together using end-to-end anastomosis. The l ongitudinal pyloromyotomy then was closed diagonally above the reconstructe d pyloric neocanal. Results: The postoperative course was uneventful: oral feeding was started on the 11th postoperative day. At 4 year follow-up the child was well; no g astrointestinal disorders were present, confirmed by x-ray barium meal and by HIDA technetium Tc 99m hepatic scintiscan, which excluded any bilious du odeno-gastric reflux. Conclusion: This technique of pyloric sphincter reconstruction allows prese rvation of the pyloric sphincter, whose sphincter muscular layer, although hypoplastic, is present in cases of pyloric atresia. J Pediatr Surg 35:1372 -1374, Copyright (C) 2000 by W.B. Saunders Company.