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Physiological and functional evaluation of the transposed human pylorus as a distal sphincter.

Chandra A, Ghoshal UC, Gupta V, Jauhari R, Srivastava RN, Misra A, Kumar A, Kumar M - J Neurogastroenterol Motil (2012)

Bottom Line: In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively.On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve.The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Gastroenterology, CSM Medical University, Lucknow, India.

ABSTRACT

Background/aims: Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position.

Methods: Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position.

Results: The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position.

Conclusions: The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity.

No MeSH data available.


Related in: MedlinePlus

Transposed pyloric valve as seen during colonoscopic examination. Pyloric valve appeared closed with intermittent relaxation during prolonged examination.
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Figure 3: Transposed pyloric valve as seen during colonoscopic examination. Pyloric valve appeared closed with intermittent relaxation during prolonged examination.

Mentions: The pylorus was examined through the distal loop of diverting colostomy and also per-anally during colonoscopy to assess its activity (Fig. 3).


Physiological and functional evaluation of the transposed human pylorus as a distal sphincter.

Chandra A, Ghoshal UC, Gupta V, Jauhari R, Srivastava RN, Misra A, Kumar A, Kumar M - J Neurogastroenterol Motil (2012)

Transposed pyloric valve as seen during colonoscopic examination. Pyloric valve appeared closed with intermittent relaxation during prolonged examination.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3400814&req=5

Figure 3: Transposed pyloric valve as seen during colonoscopic examination. Pyloric valve appeared closed with intermittent relaxation during prolonged examination.
Mentions: The pylorus was examined through the distal loop of diverting colostomy and also per-anally during colonoscopy to assess its activity (Fig. 3).

Bottom Line: In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively.On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve.The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgical Gastroenterology, CSM Medical University, Lucknow, India.

ABSTRACT

Background/aims: Studies evaluating the human pylorus as a sphincter are scanty and contradictory. Recently, we have shown technical feasibility of transposing the human pylorus for end-stage fecal incontinence. This unique cohort of patients provided us an opportunity to study the sphincter properties of the pylorus in its ectopic position.

Methods: Antro-pylorus transposition on end sigmoid colostomies (n = 3) and in the perineum (n = 15) was performed for various indications. Antro-pylorus was assessed functionally (digital examination, high resolution spatiotemporal manometry, barium retention studies and colonoscopy) and by imaging (doppler ultrasound, MRI and CT angiography) in its ectopic position.

Results: The median resting pressure of pylorus on colostomy was 30 mmHg (range 28-38). In benign group, median resting pressure in perineum was 12.5 mmHg (range 6-44) that increased to 21.5 mmHg (range 12-29) (P = 0.481) and 31 mmHg (range 16-77) (P = 0.034) on first and second follow-up, respectively. In malignant group, median post-operative pressures were 20 mmHg (range 14-36) and 21 mmHg (range 18-44) on first and second follow-up, respectively. A definite tone and gripping sensation were felt in all the patients on digital examination. On distal loopogram, performed through the diverting colostomies, barium was retained proximal to the neo-pyloric valve. Both perineal ultrasound and MRI showed viable transposed graft. CT angiography and color doppler studies confirmed vascular flow in the transposed position.

Conclusions: The human pyloric valve can function as a tonic sphincter when removed from the gastroduodenal continuity.

No MeSH data available.


Related in: MedlinePlus