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Fetal & Pediatric Surgery (Expert Forum)
Is a pyloroplasty reversible?
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The Children’s Hospital of Philadelphia
Questions in this forum are answered by pediatric and fetal surgeons from The Children's Hospital of Philadelphia. This forum is for questions and support about issues such as abdominal and thoracic surgery, minimally invasive surgery, oncologic surgery, trauma surgery, fetal surgery and surgery to treat congenital disorders and malformations.
Is a pyloroplasty reversible?
by katisimba, Oct 03, 2009 02:35PM
My 5 year old son stopped eating due to reflux at the age of 4 months. He had a g-tube placed and a laproscopic fundoplication. This did not help he was still refluxing. He then had a nissen fundoplication and a finney pyloroplasty.
After this surgery he developed dumping syndrome.He was weaned off tube feedings 2 years ago and eating is still a struggle. He is severly underweight and wakes up screaming at night. We went to the hospital this week and he was scoped. They found out that he has erosive gastritis, bile reflux and duodenditis. I am still waiting on other results.
Is there any way that the pyloroplasty which is probably the cause of his current problems reversible?
Thank you
After this surgery he developed dumping syndrome.He was weaned off tube feedings 2 years ago and eating is still a struggle. He is severly underweight and wakes up screaming at night. We went to the hospital this week and he was scoped. They found out that he has erosive gastritis, bile reflux and duodenditis. I am still waiting on other results.
Is there any way that the pyloroplasty which is probably the cause of his current problems reversible?
Thank you
Doctor's Answer
by Thane A Blinman, MD, FAAP, Oct 06, 2009 04:35PM
, Oct 06, 2009 04:35PM
So sorry to hear about your struggles.
It is likely that the pyloroplasty contributes to both the dumping syndrome and the gastritis. The dumping (there are two types, and you do not describe which, but "early dumping" would be likely in your case: cramps, jitters, bloat, diarrhea. "Late dumping" is a severe reactive hypoglycemia) happens when a smaller stomach (from the Nissen) encounters and incompetent pylorus. Gastric contents leave too fast, producing the symptoms (the small bowel reacts badly to too-high volumes of too-high concentration).
The gastritis may also stem from an incompetent pylorus--bile and strongly alkaline fluid from the pancreas and duodenum flow back into the stomach which has evolved to tolerate strong acid, but has trouble with strong base. This is very hard to treat, but some have reported good results (and I have seen this too) with Carafate. There are also several medical strategies that could be tried, some just involving changes in how and what he eats and what medications you use.
Reversal of pyloropplasty has been reported as successful, but is not at all common (fewer pediatric surgeons even do pyloroplasties any more for the reasons you have experienced). In an extreme case there are operations that could be done as well, but may be no better than what you have.
Ask your surgeon about reversal. And consider a second opinion.
T.
It is likely that the pyloroplasty contributes to both the dumping syndrome and the gastritis. The dumping (there are two types, and you do not describe which, but "early dumping" would be likely in your case: cramps, jitters, bloat, diarrhea. "Late dumping" is a severe reactive hypoglycemia) happens when a smaller stomach (from the Nissen) encounters and incompetent pylorus. Gastric contents leave too fast, producing the symptoms (the small bowel reacts badly to too-high volumes of too-high concentration).
The gastritis may also stem from an incompetent pylorus--bile and strongly alkaline fluid from the pancreas and duodenum flow back into the stomach which has evolved to tolerate strong acid, but has trouble with strong base. This is very hard to treat, but some have reported good results (and I have seen this too) with Carafate. There are also several medical strategies that could be tried, some just involving changes in how and what he eats and what medications you use.
Reversal of pyloropplasty has been reported as successful, but is not at all common (fewer pediatric surgeons even do pyloroplasties any more for the reasons you have experienced). In an extreme case there are operations that could be done as well, but may be no better than what you have.
Ask your surgeon about reversal. And consider a second opinion.
T.
Member Comments (2)
by monkey122296, Oct 23, 2009 10:58AM
To: katisimba
hide all the food and slowly give him only water then move on up to food but only give him little servings so his digestive system gets used to that amount of food and then he won't eat so much.
