Longitudinal and transverse slit pyloroplasty

This type of surgery is suitable for the pyloric scar and adhesion is not very serious, do not need to separate duodenal ulcer of the duodenum. For example, the anterior wall perforation can be removed together, and the posterior wall bleeding can simultaneously sew the bleeding blood vessels. If the scar is widely adhered and the duodenum needs to be separated, it can be used as a horseshoe-shaped pyloric angioplasty (Finney). Generally, at the same time as pyloric angioplasty, vagus nerve cutting is performed first, and then pyloric angioplasty is performed to avoid contamination of the mediastinum. Only for patients with bleeding, pyloric angioplasty should be performed first, and the bleeding point should be ligated before vagus nerve cutting. Treatment of diseases: pyloric obstruction congenital hypertrophic pyloric stenosis Indication 1. Pyloric obstruction caused by gastric cancer, the tumor has been fixed, can not be removed, can be used for gastric jejunostomy to relieve obstruction. 2. Gastric ulcer caused by pyloric obstruction, the condition is heavy, can not tolerate partial resection of the stomach, and because of such patients with low gastric acid, can be used for gastric jejunostomy. 3. Duodenal ulcer complicated with pyloric obstruction, the patient is in poor condition, can not tolerate the majority of gastric resection, can perform gastric vagus nerve cutting to reduce gastric acid, and add gastric drainage (such as pyloricplasty, stomach Duodenal anastomosis or gastrojejunostomy) to relieve retention of stomach contents. Preoperative preparation 1. Patients with pyloric obstruction, due to the retention of gastric contents, bacteria are easy to multiply, resulting in mucosal congestion and edema, which hinders the healing of postoperative anastomotic stoma. Fasting before surgery, gastric lavage before surgery, so that the stomach is drained as much as possible to reduce inflammation. 2. Appropriate fluid replacement, blood transfusion, and correction of water and electrolyte imbalance. 3. Before entering the operating room, the stomach tube should be taken out to evacuate the stomach contents to avoid vomiting during anesthesia, causing asphyxia and pulmonary complications. Surgical procedure 1. Position, incision: supine position. The median incision in the upper abdomen or the inferior rectus abdominis incision. 2. Select the incision site of the anterior wall: in the anterior wall of the pylorus, along the stomach, the longitudinal axis of the duodenum, the incision is selected across the sphincter. The length is about 6 to 7 cm (about 3.5 cm on the stomach side and about 2.5 cm on the duodenal bulb), and the total length should not exceed 7 cm. 3. Cut the front wall: pad the gauze around the anastomosis, and sew a pull line on both sides of the midpoint of the predetermined incision. The stomach, the intestinal wall and the pyloric sphincter are cut in the whole layer between the traction lines, the submucosal bleeding points are sutured, and the contents of the stomach and intestine are sucked out. 4. Formability anastomosis: firstly, the stomach wall and the duodenal wall of the two corners of the incision are sutured with a medium-sized silk thread for a full-thickness. The knot is not tightened until the traction line is tightened up and down. Tighten the knot and slowly pull the two corners together to make the original longitudinal cut into a transverse cut. The entire incision was then sutured with a full layer of silk suture. 5. Muscle layer suture: suture the muscle layer from the lower corner. First suture the lower corner with a half-powder, knotted and fixed. The same line was used to continue the continuous varus suture (Cushing) to the upper corner, and the upper corner was also sutured with a half-powder to complete the suture of the sarcoplasmic layer. After removing the contaminated gauze, wash your hands or change gloves after surgery. 6. Covering the omentum: After detecting the smoothness of the anastomosis outside the stomach and the intestinal wall with a finger, the incision is covered with a large and small omentum, and the suture is fixed through the omentum to the stomach wall. The abdominal wall is sutured by layer.