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Treatment With Pyloric Exclusion and Gastrojejunostomy

Tomas D. Martin, MD; David V. Feliciano, MD; Kenneth L. Mattox, MD; George L. Jordan, Jr, MD

Arch Surg. 1983;118(5):631-635.

Abstract
• During a 12-year period, 313 patients with duodenal injuries were treated. Primary repair, pyloric exclusion, and gastrojejunostomy were used in 128 patients (41%) with severe duodenal and pancreaticoduodenal injuries, to reduce "duodenal" morbidity and mortality. The duodenal fistula rate was 2.2% overall, and 5.5% in the patients undergoing exclusion. Only two deaths were due to fistulas. Forty-two patients underwent upper gastrointestinal tract examinations after operation. In patients examined 21 days or more after operation, 94% had a patent pylorus. Marginal ulceration was infrequent (four patients), as were complications associated with the procedure (3%). Pyloric exclusion with gastrojejunostomy is a quick and simple procedure that allows return of pyloric patency and is associated with a low incidence of duodenal fistulas. When fistulas do develop, they are usually easily controlled and are associated with a low mortality. We believe pyloric exclusion with gastrojejunostomy to be the procedure of choice in patients with severe duodenal and pancreaticoduodenal trauma.

(Arch Surg 1983;118:631-635)

Author Affiliations
From the Cora and Webb Mading Department of Surgery, Baylor College of Medicine and the Ben Taub General Hospital, Houston.

Footnotes
Accepted for publication Jan 3, 1983.

Read before the 90th annual meeting of the Western Surgical Association, Kansas City, Mo, Nov 16, 1982.

Reprint requests to Department of Surgery, Baylor College of Medicine, 1200 Moursund Ave, Houston, TX 77030 (Dr Feliciano).

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