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Pyloroplasty, GOO - Coggle Diagram
Pyloroplasty
Finney
Mobilize the first and second portions of the duodenum by performing a Kocher maneuver.
With interrupted Lembert suture of 3–0 silk, appose the pyloric area of the stomach and the first portion of the duodenum.
Make a U-shaped, inverted incision to include the distal pyloric antrum and the proximal second portion of the duodenum.
Close the gastroduodenal opening in layers, inner layer with a running PDS 3–0 stitch and outer with interrupted 3–0 silk Lemberts.
Truncal vagotomy may be done if surgery is performed immediately after the perforation of the ulcer.
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If you have pyloric permeability, use this surgical technique
INDICATIONS
- Vagus innervation of the stomach interrupted
- Truncal vagotomy
- Selective vagotomy
- Division of vagus nerves c esophagogastric resection.
- GOO
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Heineke-Mikulicz
Technique
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Perform a Kocher maneuver.
Place two sutures, one superior and one inferior to the middle of the proposed longitudinal (include pyloric vein)
Pyloroduodenal incision all layers of anterior wall Gambi suture
Close the transverse duodenotomy in a longitudinal fashion. One layer closure
Apply traction on the two previously placed sutures and close in two layers using 3–0 PDS and 3–0 silk.
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ANATOMY
Pylorus
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Innervation
Anterior hepatic plexus via the route of the suprapyloric/supraduodenal branch of the right gastric artery
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Posterior-lower region of the pyloric region, which passed via the infrapyloric artery or retroduodenal branches and was related to the gastroduodenal artery and right gastroepiploic artery
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Venous drainage
Right gastric vein runs along the lesser curvature to the right toward the pylorus.
Posterior to the first part of the duodenum, it joins the portal vein.
Components:
- Pyloric Antrum
- Pyloric valve
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Mx. layers:
- Longitudinal outer
- Intermediate main circular
- Minor longitudinal
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PHYSIOLOGY
- Prevent intestinal contents from reentering the stomach when the small intestine contracts
- Limit the passage of large food particles or undigested material into the intestine.
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GOO
Gastric volvulus
Triada de Borchardt 70%
- Vómito no productivo
- Dolor
- Imposibilidad al paso de la sonda
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