OBJECTIVETo investigate the efficacy of surgical management for pyloric stenosis induced by gastrointestinal chemical burn in children.

METHODSClinical data of 11 children with pyloric stenosis induced by gastrointestinal chemical burn were analyzed retrospectively. After the failure of medicine, intervention of low balloon expansion and stent placement, they underwent pylorectomy and gastroduodenostomy. The body weight, height, serum albumin, hemoglobin, transferrin were compared between 1 day before and 3 months after operation.

RESULTSThere were 10 males and 1 female with a mean age of 4.5 years old. The main cause of serious pyloric stenosis was the wrong intake of hydrochloric acid. Lesions involved the esophagus and stomach in the early stage, and 4 weeks later, the lesion mainly involved the pylorus, which resulted in scarring pyloric stenosis and complete pyloric obstruction. Pylorectomy and gastroduodenostomy was successfully performed. The mean operative time was (134±26) min. The estimated blood loss was (5±2) ml. The postoperative length of stay was (10±3) d. There were no surgical complications. During the follow-up of 3 months, all the patients resumed regular diet. The height, body weight, and intelligence appeared to be normal. They showed significant improvement in weight, serum albumin, globulin, hemoglobin, transferrin at 3 months after the surgery(P<0.05). Six months after surgery, the anastomosis was shown to be nornal in barium follow through exam with no signs of stricture of ulcer.

CONCLUSIONPylorectomy and gastroduodenostomy is an effective management for pyloric stenosis induced by gastrointestinal chemical burn in children, whose short-term efficacy is good.

Burns, Chemical ; Child ; Gastrectomy ; Gastroenterostomy ; Humans ; Pyloric Stenosis ; Pylorus ; surgery

Objective: To assess the effect of jejunal feeding tube placement on early complications of laparoscopic radical gastrectomy in patients with incomplete pyloric obstruction by gastric cancer. Methods: This was a retrospective cohort study. Perioperative clinical data of 151 patients with gastric antrum cancer complicated by incomplete pyloric obstruction who had undergone laparoscopic distal radical gastrectomy from May 2020 to May 2022 in the First Affiliated Hospital of Nanchang University were collected. Intraoperative jejunal feeding tubes had been inserted in 69 patients (nutrition tube group) and not in the remaining 82 patients (conventional group). There were no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The operating time, intraoperative bleeding, time to first intake of solid food, time to passing first flatus, time to drainage tube removal, and postoperative hospital stay, and early postoperative complications (occurded within 30 days after surgery) were compared between the two groups. Results: Patients in both groups completed the surgery successfully and there were no deaths in the perioperative period. The operative time was longer in the nutritional tube group than in the conventional group [(209.2±4.7) minutes vs. (188.5±5.7) minutes, t=2.737, P=0.007], whereas the time to first postoperative intake of food [(2.7±0.1) days vs. (4.1±0.4) days, t=3.535, P<0.001], time to passing first flatus [(2.3±0.1) days vs. (2.8±0.1) days, t=3.999, P<0.001], time to drainage tube removal [(6.3±0.2) days vs. (6.9±0.2) days, t=2.123, P=0.035], and postoperative hospital stay [(7.8±0.2) days vs. (9.7±0.5) days, t=3.282, P=0.001] were shorter in the nutritional tube group than in the conventional group. There was no significant difference between the two groups in intraoperative bleeding [(101.1±9.0) mL vs. (111.4±8.7) mL, t=0.826, P=0.410]. The overall incidence of short-term postoperative complications was 16.6% (25/151). Postoperative complications did not differ significantly between the two groups (all P>0.05). Conclusion: It is safe and feasible to insert a jejunal feeding tube in patients with incomplete outlet obstruction by gastric antrum cancer during laparoscopic radical gastrectomy. Such tubes confer some advantages in postoperative recovery.
Humans ; Stomach Neoplasms/etiology* ; Pyloric Antrum ; Retrospective Studies ; Flatulence/surgery* ; Treatment Outcome ; Postoperative Complications/etiology* ; Laparoscopy ; Gastrectomy/adverse effects* ; Length of Stay ; Pyloric Stenosis/surgery*

Female ; Hernia, Inguinal ; surgery ; Humans ; Incidence ; Infant ; Infant, Newborn ; Laparoscopy ; methods ; Male ; Pyloric Stenosis, Hypertrophic ; epidemiology ; surgery ; Retrospective Studies

OBJECTIVETo evaluate the effect of the treatment of congenital hypertrophic pyloric stenosis (CHPS) with endoscopic pyloromyotomy.

METHODNine consecutive infants (7 boys, 2 girls; age range 26 - 70 days; weight range 2.65 - 6.10 kg), with a diagnosis of CHPS according to typical clinical manifestations, transabdominal ultrasound (US), gastroenterography and gastroscope. All the cases had accompanying malnutrition, anaemia, metabolic alkalosis, and some were complicated with congenital heart disease. In gastroscope operating room, all the patients were given pentobarbital and midazolam intravenously. A gastroscope with an outer diameter of 5.9 mm was passed through mouth, stomach, pylorus to the descending segment of duodenum. Under gastroscopy, two incisions were made along the anterior and posterior wall of pylorus from the duodenal bulb to the antrum by using endoscopic electrosurgical needle knife and an arch sphincter sarcosome. Incisions were deepened by 2 to 3 procedures until the longitudinal muscle was exposed, about 2 to 4 mm according to transabdominal US performed before operation. The incision depth was 2 - 3 mm if pylorus wall was 4 - 6 mm in thickness; or 3 - 4 mm when the wall was thicker than 6 mm.

RESULTThe endoscope was easily passed through the pylorus to the duodenum post-operation. The transabdominal US and gastroenterography showed that liquid easily flew through pylorus. All patients were able to have regular feeding about 2 to 10 hours after the operation. Vomiting in all patients was significantly decreased in frequency and amount, and in 8 infants vomiting stopped within 1 week, in one case it did not stop until 1 month after the treatment. Some cases showed slight adverse reaction, no perforation or massive haemorrhage in stomach or intestines occurred in any of the patients during and post-operation. Eight infants were doing well at follow-up (range 2 to 9 months). One girl had recurred vomiting at normal feeding after a period of 1 month postoperation without vomiting. This case was cured by second endoscopic pyloromyotomy.

CONCLUSIONSEndoscopic pyloromyotomy is effective, safe, simple, and offers several advantages: no need for open-abdomen surgery, feeding can be initiated rapidly.

Female ; Humans ; Infant ; Infant, Newborn ; Male ; Pyloric Stenosis, Hypertrophic ; congenital ; surgery ; Pylorus ; surgery ; Sphincterotomy, Endoscopic ; ethics ; methods

OBJECTIVETo investigate the impact of pyloric stenosis on the prognosis after D2 radical resection for advanced distal gastric cancer.

METHODSClinical data of 284 patients with advanced distal gastric cancer who underwent D2 radical resection from January 1998 to December 2004 were analyzed retrospectively. Clinicopathologic variables, survival outcomes, and postoperative morbidity and mortality were compared between patients who developed pyloric stenosis (n=69) and those without pyloric stenosis (n=215).

RESULTSThe 5-year survival rate was 38.8% in patients with pyloric stenosis and 62.4% in those without pyloric stenosis, and the difference was statistically significant (P<0.05). Cox regression model showed that pyloric stenosis, tumor size, depth of invasion, and lymph node involvement were independent predictors for survival. There were no significant differences between the two groups in postoperative morbidity (13.0% vs. 10.2%, P>0.05) or mortality (2.9% vs. 1.4%, P>0.05).

CONCLUSIONSPyloric stenosis is associated with poor survival for patients undergoing D2 radical resection for advanced distal gastric cancer. However, pyloric stenosis does not increase postoperative morbidity and mortality related to surgery.

Aged ; Female ; Follow-Up Studies ; Gastrectomy ; Humans ; Male ; Middle Aged ; Prognosis ; Pyloric Stenosis ; complications ; Retrospective Studies ; Stomach Neoplasms ; complications ; surgery ; Survival Rate