Y-U advancement pyloroplasty.

Heineke in 1886 and von Mikulicz in 1887 independently described the popular method of pyloroplasty by longitudinal incision and transverse closure. In some patients, particularly children, the Heineke-Mikulicz procedure has not always been satisfactory because of inadequate size and distortion of the muscular gastroduodenal funnel. In 1958, Moschel and co-workers reintroduced the concept of the Y-V advancement principle to enlarge the pylorus. This operation has not been widely adopted but has a number of attractive features, including simplicity, safety, and maximal channel size with minimal operating time. The standard Y-V principle has been modified in favor of a broadly based U-shaped pedicle constructed from the presenting surface of the gastric antrum which is advanced into an incision made in the anterior duodenum. This operation has been used in 33 patients, who range in age from 3 weeks to 17 years. They have been variously followed from 6 months to 10 years. The surgical need for pyloroplasty in this group of patients included hiatal hernia with delayed gastric emptying (19 patients); vagotomy for ulcer (7 patients); esophageal substitution (4 patients); vagotomy for reflux esophagitis (2 patients); and, in one instance, revision of an obstructed Heineke-Mikulicz pyloroplasty. Complications have been minimal; gastric drainage has been highly satisfactory. In long-term followup, no ill effect has been seen from the presence of antral mucosa in the proximal duodenum.