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LETTER TO EDITOR |
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| Year : 2011 | Volume
: 16
| Issue : 1 | Page : 34-35 |
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Laparoscopic vagotomy with gastrojejunostomy for corrosive pyloric strictures
A Prasad, KA Mukherjee, M Kaur, M Ali, S Kaul
Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi, India
| Date of Web Publication | 3-Jan-2011 |
Correspondence Address:
A Prasad
Department of Minimal Access Surgery, Indraprastha Apollo Hospital, New Delhi
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0971-9261.74523
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 2020 Nov 28];16:34-5. Available from: https://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]
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 | |  |
| 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. 
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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.
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| 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.
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| 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.
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| 5. | Collure DW. Pyloric obstruction following the ingestion of corrosive acid. Ceylon Med J 1989;34:135-7.
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[Figure 1]
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