Replacement of the pyloric sphincter with the ileocecal valve: an experimental study.

BACKGROUND: Several surgical methods have been devised and applied to overcome the complications associated with the loss of the pyloric sphincter after distal gastrectomy. However, none of these methods creates an efficient sphincteric mechanism at the anastomotic site. The purpose of this experimental study in dogs was to replace the pylorus with the ileocecal valve and determine whether its sphincteric function would be preserved in its new location without affecting gastrointestinal motility and the health of the animals. METHODS: Thirteen dogs underwent surgical removal of the pyloric sphincter and a partial distal gastrectomy. The ileocecal valve, with a short segment of ileum, was then relocated so that the ileal segment was anastomosed to the stomach while the cecal segment was anastomosed to the duodenum. Intestinal continuity was reestablished by anastomosing the distal ileum with the ascending colon. Intraileal and intracolic pressures were measured in all animals prior to and following transposition of the ileocecal valve. In 3 of these animals, pre-pyloric (intragastric) and post-pyloric (intraduodenal) pressures were also measured before the pylorus was removed. Pressure measurements on both sides of the transposed ileocecal valve were performed again 4-6 months later. All pressure measurements were made directly with a water manometer. Radiographic and fluoroscopic studies were carried out on all animals to assess gastrointestinal motility, gastric emptying times, and the sphincteric competence of the transposed ileocecal valve. Hematological and biochemical studies intended to assess the nutritional status of all animals were carried out. Also, postoperative measurements were made of gastric basic acid output. RESULTS: All animals were alive and well 4-6 months after the initial operative procedure. Hematological studies and biochemical tests and studies of liver function remained normal. There was a slight reduction in serum B12 levels and, as expected, a significant postoperative reduction in gastric basic acid output. The intraluminal pressure measurements and the radiographic and fluoroscopic studies all showed that the sphincteric mechanism of the ileocecal valve was preserved in its new location, that gastrointestinal motility was not impaired, and that the healthy condition of the animals was maintained. Gross and histological examination of the transposed segments of the intestinal tract did not reveal any abnormalities. CONCLUSION: Because the anatomy and physiology of the human alimentary tract are similar to those of the dog, this technique may be applicable clinically, when indicated, to avoid and/or relieve complications resulting from gastrectomy, when those complications do not respond or have not responded to conservative management.

Use of the pylorus for preventing ileostomy complications. An experimental canine study.

PURPOSE: Conventional ileostomy, as it is well known, presents with persistent watery diarrhea, among other complications. The present-day modified methods of conventional ileostomy cannot effectively prevent these unpleasant consequences. The purpose of this study was to try to use the sphincter mechanism of the pylorus in ileostomy in dogs experimentally to prevent the above symptoms. METHOD: Following a highly selective vagotomy, the antrum with the pylorus and a 3-cm segment of the duodenum were separated from the gastrointestinal tract along with its vasculature and innervation, and the distal duodenal end was closed. Then, the terminal loop of ileum (before an ileostomy was performed) was dissected, and the distal segment was anastomosed with the proximal end of duodenum; the proximal segment of this loop was anastomosed with the stump of the antrum. The gastrointestinal continuity was established by anastomosis of the gastric stump to the first loop of the jejunum. RESULTS: After the procedure, the sphincter mechanism of the pylorus was preserved, and bowel movements became solid and infrequent, so a colostomy bag could be applied consistently. CONCLUSIONS: Similarity of anatomy and physiology of the alimentary tract in dogs and human favors possible application of this procedure to humans, with better results than with conventional ileostomy.

Perforated chronic duodenal ulcer in children with coexistence of acute appendicitis.

Two cases of perforation of duodenal ulcer with coexistence of acute appendicitis are reported. Current concepts regarding this unusual complication of childhood duodenal ulcer are discussed.

Treatment of pilonidal sinus disease with the Z-plasty procedure (modified).

This article points out the significance of the internatal cleft for the formation of pilonidal sinus. Elimination of the internatal cleft by means of Z-plasty carries the smallest recurrence rate. The author, in an attempt to eliminate this small recurrence rate, applied a modified Z-plasty which is described in the present communication, and which was successfully applied in a series of cases of pilonidal sinus.