Pyloric resection with Billroth 1 gastroduodenostomy versus bypass loop gastrojejunostomy for the management of post corrosive long segment pyloric stricture: a retrospective study

Abstract

Background Accidental or suicidal ingestion of corrosive substances remains a major public health problem. Worldwide, the causative materials for corrosive injury are not the same. Surgery remains the mainstay of treatment with available different surgical options. The selected surgical technique should offer symptomatic treatment with less postoperative morbidity. Patients and methods Retrospective evaluation of 62 patients with long segment pyloric stricture postacid ingestion presenting with gastric outlet obstruction in the period between May 2017 and June 2022. They were divided into two groups, (group A (n=24), managed by Billroth 1 gastroduodenostomy; group B (n=38), managed by bypass loop gastrojejunostomy). Results In group A, the age ranged 3–59 years with a mean age of 25.7±22.62 years, while in group B, the age ranged 2.5–63 years with a mean age of 19.72±15.71 years. The type of ingested corrosive was hydrochloric acid in 60 patients (96.77%), while in two (3.23%) patients the exact acid was unknown. The interval between initial acid ingestion and symptoms of gastric outlet obstruction was 3 weeks to 18 months. In group A, the mean operative time was 64.125±7.023 min, while in group B, it was 61.763±7.837 min. Postoperative vomiting occurred in three (12.5%) patients in group A and in six (15.78%) patients in group B. In group A, the mean hospital stay was 5.5±0.932 days, while in group B, it was 4.921±1.806 days. Conclusion Billroth 1 gastroduodenostomy has the superiority of prophylaxis against long-term low risk of future malignancy. Bypass loop gastrojejunostomy is a safer alternative to Billroth 1 gastroduodenostomy, especially in the presence of severe perigastric adhesions and malnutrition. Future studies should include a large sample of patients with long periods of follow-up.