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LETTER TO EDITOR
Year : 2011  |  Volume : 16  |  Issue : 1  |  Page : 34-35
 

Laparoscopic vagotomy with gastrojejunostomy for corrosive pyloric strictures


Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi, India

Date of Web Publication3-Jan-2011

Correspondence Address:
A Prasad
Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.74523

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How to cite this article:
Prasad A, Mukherjee K A, Kaur M, Ali M, Kaul S. Laparoscopic vagotomy with gastrojejunostomy for corrosive pyloric strictures. J Indian Assoc Pediatr Surg 2011;16:34-5

How to cite this URL:
Prasad A, Mukherjee K A, Kaur M, Ali M, Kaul S. Laparoscopic vagotomy with gastrojejunostomy for corrosive pyloric strictures. J Indian Assoc Pediatr Surg [serial online] 2011 [cited 2017 Apr 23];16:34-5. Available from: http://www.jiaps.com/text.asp?2011/16/1/34/74523


Sir,

We read with interest the recent article "Pyloric and antral strictures following corrosive acid ingestion" by Shukla et al. [1]

Gastrojejunostomy has been suggested as the treatment of pyloric stricture secondary to corrosive injury. [2] Laparoscopic approach is better than open because of lesser blood loss, lesser morbidity, and early recovery. [3] Postoperative stay of the patient in the hospital is reduced. There is also a reduced incidence of wound site infection.

We do a laparoscopic truncal vagotomy [Figure 1] with gastrojejunostomy for such patients as there is a significant risk of development of stomal ulcers if vagotomy is not done along with gastrojejunostomy. [4] There have been suggestions that the corrosive would have destroyed the acid producing cells, but no evidence to this effect has been shown in any scientific study. [5]
Figure 1: Laparoscopic vagotomy

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We recently had a 15-year-old female with a history of toilet cleaner (acid) ingestion. She had been treated conservatively with gastric lavage and was subsequently discharged with no complications. After 1 month of this episode, she presented to our hospital with recurrent vomitings which was initially to solids and later progressed to liquids. The patient had 7 kg weight loss in a month and was nutritionally depleted. An upper GI endoscopy showed narrowing at pylorus with a normal esophagus. This is consistent with the "licks the esophagus and bites the pylorus" hypothesis. [1] This patient underwent a laparoscopic vagotomy with gastrojejunostomy and made a rapid recovery.

We would like to suggest that these patients should be offered a laparoscopic gastrojejunostomy for all the benefits of minimal access surgery and a vagotomy should be added to avoid the delayed complication of stomal ulceration.

 
   References Top

1.Shukla RM, Mukhopadhyay M, Tripathy BB, Mandal KC, Mukhopadhyay B. Pyloric and antral strictures following corrosive acid ingestion: A report of four cases. J Indian Assoc Pediatr Surg 2010;15:108-9.  Back to cited text no. 1
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2.Ozcana C, Erquna O, Sena T, Mutafa O. Gastric outlet obstruction secondary to acid ingestion in children. J Pediatric Surg 2004;39:1651-3.  Back to cited text no. 2
    
3.Bergamaschi R, Mårvik R, Thoresen JE, Ystgaard B, Johnsen G, Myrvold HE.Open versus laparoscopic gastrojejunostomy for palliation in advanced pancreatic cancer. Surg Laparosc Endosc 1998;8:92-6.  Back to cited text no. 3
    
4.Willams NS, Bulstrode CJK, O'Connel PR. Bailey and Love's short practice of surgery: Stomach and Duodenum: 25 th ed. London: Edward Arnold; 2008. p. 1059.  Back to cited text no. 4
    
5.Collure DW. Pyloric obstruction following the ingestion of corrosive acid. Ceylon Med J 1989;34:135-7.  Back to cited text no. 5
    


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