Controlled reopen suture technique for pyloric exclusion

Jen Feng Fang, Ray Jade Chen, Being Chuan Lin

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background: Pyloric exclusion had been widely used in the management of complicated duodenal injuries. The original concept of pyloric exclusion was that this technique would temporarily exclude the pylorus during the healing phase, but would subsequently allow resumption of normal gastrointestinal tract transit through the duodenum. The best method for pyloric exclusion has not been well established. Controversies exist regarding the need for a gastrojejunostomy and vagotomy as part of the procedure. None of these combinations can fulfill the original concept 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 II) with a complicated blunt duodenal injury over the past 5 years. The clinical courses and outcomes of these patients were compared with an eight-patient comparison group treated by pyloric exclusion and gastrojejunostomy (group I) over the same time period. Results: All 17 patients survived. There were one early (duodenal wound leakage) and two late complications (marginal ulcers) in the group I patients. No delayed complications were found in the group II patients. The average hospital stay was about the same in both groups. Conclusion: The controlled reopen suture technique is a quick and simple procedure. In the treatment of a complicated blunt duodenal injury, if repair of the duodenal wound will not compromise the lumen, gastrojejunostomy and vagotomy can be omitted when using this technique. This technique offers the best combination of limited 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 duodenum. The late complications of gastrojejunostomy can also be avoided.

Original languageEnglish
Pages (from-to)593-596
Number of pages4
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume45
Issue number3
DOIs
Publication statusPublished - Sep 1998
Externally publishedYes

Keywords

  • Duodenal injury
  • Marginal ulcer
  • Pyloric exclusion

ASJC Scopus subject areas

  • Surgery

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