Heineke-Mikulicz Pyloroplasty Research Articles

Surgical management of corrosive-induced gastric injury in children: 10 years' experience

The purpose of this study was to report surgical management and outcome of corrosive-induced gastric injuries in children at our institute over the last decade. Medical records of patients admitted for corrosive-induced gastric injury at the Pediatric Surgery Department of Ain Shams University between January 2007 and January 2017 were retrospectively reviewed. Twenty six cases (17 boys and 9 girls) were enrolled. Mean age was 3.61±1.29. Ingested agent was acid in all the patients. Main presenting symptom was gastric output obstruction in 22 cases. The interval between corrosive ingestion and presentation ranged from one to 135days (mean=43.9±34). Surgical procedure included total gastrectomy (n=2), partial gastrectomy (n=2), augmentation gastroplasty (n=1), Billroth I (n=2), antrectomy (n=2), antroplasty (n=3), gastrojejunostomy (n=2), Heineke-Mikulicz pyloroplasty (n=9), Finney pyloroplasty (n=5), and feeding jejunostomy (n=4). Anastomotic stricture requiring a second operation developed in one patient. There were three mortalities related to the associated esophageal strictures. The mean follow-up period is 3.5years. All patients are free of symptoms and gained adequate weight. Surgery is the mainstay of management for corrosive-induced gastric injuries with good long-term results. Surgical procedure should be tailored according to the patient's general condition and extent of gastric injury. This is a case series with no comparison group (level IV).

Pyloroplasty Offers Relief of Postfundoplication Gastroparesis in Patients Who Improved After Botulinum Toxin Injection.

Endoscopic intrapyloric Botox (onabotulinumtoxin A; Allergan Pharmaceuticals) injections can improve postfundoplication gastroparesis, but responses are not durable. Surgical pyloroplasty may relieve gastroparetic symptoms, but patient selection criteria are poorly defined. We hypothesize that pyloroplasty provides durable improvement in patients whose symptoms improved after Botox injection. A retrospective chart review was performed of patients with postfundoplication gastroparesis who improved after Botox injection and then underwent pyloroplasty. Gastric emptying studies (GES), Gastroparesis Cardinal Symptom Index (GCSI) score, symptoms, and outcomes were reviewed. Ten patients received Heineke-Mikulicz pyloroplasty after reporting improvement with Botox injection. The mean operative time was 114 minutes (range 55-234 minutes). Three of 10 patients required conversion to open surgery, and the median length of stay was 3 days. Gastroparesis symptom improvement occurred in 9 of 10 patients. Postoperative GES normalized in 5/5 patients (median 205 decreased to 70 min, P < .05). Median preoperative GCSI was 3.67, improved to 2.22 at 1 month postsurgery (P = .010) and to 2.11 on most recent follow-up (P = .015). Median duration of follow-up was 34 months (range 1-101 months). Heineke-Mikulicz pyloroplasty can improve symptoms and gastric emptying times in patients with postfundoplication gastroparesis. Improvement with intrapyloric Botox injection may select candidates for pyloroplasty.

Gastric outlet obstruction in a 5-year-old boy: Heineke-Mikulicz pyloroplasty is curative

• Primary acquired gastric outlet obstruction in the paediatric age group is a rare disease.

The Long-Term Efficacy and Safety of Pyloroplasty Combined with Gastric Electrical Stimulation Therapy in Gastroparesis

IntroductionGastroparesis is delayed gastric emptying without mechanical obstruction. Symptomatic improvement can be 50–60% with gastric electrical stimulation. To address delayed gastric emptying, pyloroplasty was added. This study examines the long-term efficacy and safety of simultaneous gastric electrical stimulator implantation and pyloroplasty. MethodsIn this prospective single-arm trial conducted from 2012 to 2015, 27 [23 females; mean age 43 (22–63)] gastroparesis patients who underwent simultaneous gastric electrical stimulator implantation with Heineke-Mikulicz pyloroplasty were studied. Six (25%) underwent simultaneous robot-assisted pyloroplasty and gastric electrical stimulator implantation. Diagnosis of gastroparesis was based on the 4-h gastric emptying test defined as >60% retention of isotope at 2 h and >10% at 4 h. Total symptom scores assessing severity of nausea, early satiety, bloating, vomiting, post-prandial fullness, and epigastric pain were obtained at baseline and at follow-up visits, ranging from 3 to 38 months (mean: 17). ResultsFollow-up data from 24 patients were available for analysis. There was 71% improvement in total symptom score on follow-up. Mean retention decreased by 29.6 and 48.7% at 2 and 4 h and gastric emptying was normalized in 60%. There were no post-surgical complications. ConclusionsCombination of gastric electrical stimulator and pyloroplasty significantly accelerated gastric emptying and improved gastroparesis symptoms. Combining these two surgical therapies improves both subjective and objective endpoints in drug refractory gastroparesis.

Retrograde pylorogastric intussusception – Case report and review

Abstract A case of gastric outlet obstruction in an infant due to retrograde intussusception of the pylorus into the stomach is presented. This anomaly is extremely rare, with almost no reports in the literature. The patient underwent formal Heineke-Mikulicz pyloroplasty with an uneventful recovery and resumed full enteral feeding.

Laparoscopic pyloroplasty is a safe and effective first-line surgical therapy for refractory gastroparesis.

Surgical options for symptomatic delayed gastric emptying include gastric stimulator implantation, subtotal gastrectomy, and pyloroplasty. Pyloroplasty has been shown to improve gastric emptying yet is seldom described as a primary treatment for gastroparesis. We present a single-institution experience of laparoscopic Heineke-Mikulicz pyloroplasty (LP) as treatment for gastroparesis. A prospective foregut surgery database was queried for LP over a 5-year period. Charts were reviewed for indications, complications, symptom score, and outcomes. Gastroparesis was defined by (1) abnormal gastric emptying study, (2) endoscopic visualization of retained food after prolonged NPO status, or (3) clinical symptoms suspicious of vagal nerve injury following complex re-operative foregut surgery. Results were analyzed using a paired T test and single-factor ANOVA. One hundred and seventy-seven LP patients were identified and reviewed. One hundred and five had a concurrent fundoplication for objective reflux. There were no intraoperative complications or conversions to laparotomy. Overall morbidity rate was 6.8% with four return to OR and two confirmed leaks (1.1% leak rate). Average length of stay was 3.5 days, and readmission rate was 7%. Eighty-six percent had improvement in GES with normalization in 77%. Gastric emptying half-time decreased from 175 ± 94 to 91 ± 45 min. Nineteen patients (10.7%) had subsequent surgical interventions: gastric stimulator implantation (12), feeding jejunostomy and/or gastrostomy tube (6), or subtotal gastrectomy (4). Symptom severity scores for nausea, vomiting, bloating, abdominal pain, and early satiety decreased significantly at 3 months. Laparoscopic pyloroplasty improves or normalizes gastric emptying in nearly 90% of gastroparesis patients with very low morbidity. It significantly improves symptoms of nausea, vomiting, bloating, and abdominal pain. Some patients may go on to another surgical treatment for GP, but it remains a safe and less invasive alternative to a subtotal gastrectomy in these clinically challenging patients.

Adult Idiopathic Hypertrophic Pyloric Stenosis

Introduction: Adult idiopathic hypertrophic pyloric stenosis (AIHPS) is a rare entity. The most common clinical symptom is abdominal distention relieved by vomiting. There are several treatment modalities for relief of the pyloric obstruction. Case Description/Technique: A 43-year-old woman presented with a long history of epigastric pain, nausea, vomiting, and bloating, which appeared to be caused by functional dyspepsia. She also reported severe postprandial epigastric pain that was thought to be secondary to peptic ulcer disease (PUD). She had lost 7 kg, leading to a poor nutritional status. Further investigation by upper gastrointestinal endoscopy demonstrated moderate stenosis at the pylorus. After discussion, she elected to undergo laparoscopic Heineke-Mikulicz pyloroplasty. The patient was placed supine, and entrance into the peritoneal cavity was obtained with a 5-mm optical trocar. The pylorus was clearly identified and was visibly thickened. Two 2-0 silk stay sutures were placed. Gastrotomy was made with a harmonic scalpel, and the pylorus was cut. The pylorus was reconstructed horizontally by using the Heineke-Mikulicz technique. Finally, a second layer of interrupted 2-0 silk sutures was placed. Discussion: The etiology of AIHPS remains unclear. In a case report, Zarineh et al. classified AIHPS into two main types: primary and secondary. Several factors are important in establishing the diagnosis. The approaches include endoscopic dilation, gastrojejunostomy, partial gastrectomy, and pyloromyotomy with or without pyloroplasty. Despite the technical difficulty, operative procedures such as the Heineke-Mikulicz pyloroplasty have shown favorable results. Currently, laparoscopic pyloroplasty may represent a reasonable, less invasive option for this rare condition.

Robotic Duodenal Polypectomy and Pyloroplasty

Introduction: Sporadic duodenal adenomas are precancerous lesions and warrant resection due to malignant potential. The majority of duodenal adenomas are resected endoscopically. Endoscopic mucosal resection includes employing techniques, such as snare resection, submucosal injection of normal saline solution, or controlling a difficult lesion using a suction cap.1–3 The recurrence rate after resection approaches 8.3% to 45%.4,5 Lesions unamenable to endoscopic interventions require surgical resection. Open and laparoscopic techniques have been described.6–8 Although rare, robotic duodenal polypectomy has been described with successful outcomes.1,9 We demonstrate a novel technique of robotic duodenal polypectomy utilizing a pyloromyotomy to identify and resect an anatomically difficult-to-reach lesion, which was recalcitrant to multiple endoscopic resections. Materials and Methods: An 86-year-old male patient was referred for surgical excision of a duodenal polyp. The patient experienced recurrent upper and lower gastrointestinal bleeding for the past 5 years secondary to a 2 cm biopsy-confirmed duodenal adenomatous polyp. The lesion was recalcitrant to multiple endoscopic resections. On esophagogastroduodenoscopy, the location of the lesion was in the proximal duodenal bulb. The patient subsequently underwent a robotic duodenal polypectomy via a pyloromyotomy and Heineke–Mikulicz pyloroplasty. The patient was placed in supine positioning and the abdomen was entered using the Hasson technique in the right upper quadrant with a 5-mm nonbladed trocar. Under direct vision, a 5-mm port was placed in the right lateral abdominal wall, a 12-mm port in the supraumbilical position, and 8-mm ports in the right and left mid-abdomen were inserted to achieve appropriate geometry for approach to the pylorus. A combination of blunt and sharp dissection was used to mobilize the second portion of duodenum (Video). The anterior surface of the pylorus was opened in a longitudinal manner with the harmonic scalpel and extended approximately 1 cm to the first portion of the duodenum. The polyp was identified, everted into the operative bed through the pyloromyotomy, and a single PDS Endoloop® (Ethicon Endo-Surgery, Inc., Cincinnati, OH) was used to grasp the neck of the lesion. A combination of electrocautery and sharp dissection was used to excise the lesion as it was friable and prone to hemorrhage. The specimen was removed from the lumen and placed onto the extraluminal mesentary for eventual retrieval. The pyloromyotomy was then closed in a transverse manner with interrupted 0 silk sutures. Insufflations of the stomach ensured the absence of a leak, and the specimen was then retrieved with an endoscopic bag. Results and Conclusions: The patient tolerated enteric feeds on postoperative day 3 and was discharged on postoperative day 4. Upon 1-month postoperatively, his recovery remained uncomplicated. Histological findings revealed a completely resected duodenal tubular adenoma without signs of dysplasia or malignancy. Robotic resection of duodenal polyps may serve as a plausible approach in resection of duodenal lesions that are unable to be completely removed using traditional endoscopic techniques, especially lesions in the first portion of the duodenum, and in the elderly population less suitable for tolerating an exploratory laparotomy. No financial support was provided for this article. Dr. Sosin and Ms. Guevara do not have any conflict of interest nor financial ties to disclose. Dr. Gillian is a consultant and surgeon trainer for Davol and Ethicon and a proctor for Intuit Surgical. Runtime of video: 2 mins 28 secs This was presented as a poster presentation at the SAGES Annual Meeting in Baltimore, Maryland, in April 2013.

Rescue pyloroplasty for refractory delayed gastric emptying following esophagectomy

Delayed gastric emptying (DGE) following esophagectomy is a debilitating complication. Rarely, failure of postoperative endoscopic therapy may necessitate rescue pyloroplasty (rPP). We conducted a retrospective, single-institution review of rPP for post-esophagectomy DGE from 2000 to 2013. Pre- and postoperative symptoms and pharmacologic use were examined. "Successful" rPP was defined as resolution of symptoms and pharmacologic requirements postoperatively. Quality of life (QoL) was evaluated by Short Form-12 and study-specific questionnaires. Thirteen patients underwent open transabdominal rescue Heineke-Mikulicz pyloroplasty. Between esophagectomy and rPP, average interval weight loss was 19 ± 15 lb over 13 months (range, 3-22). Patients underwent 3.4 ± 1.0 preoperative endoscopic balloon dilation (EBD) attempts, with 7 (54%) receiving endoscopic intrapyloric botulinum toxin (IPB) injections. Median follow-up was 12 months (range, 4-23). After rPP, the incidence of nausea, vomiting, bloating, prokinetic use, and total parenteral nutrition/total enteral nutrition dependence decreased (all P < .01). All patients gained weight; 2 developed biliary reflux. Nine of 13 patients were identified as rPP successes; predictors of rPP failure were American Society of Anesthesiologists grade 3 (P = .02), greater number of EBD attempts (P = .02), longer time to rPP (P = .03), and fewer IPB injections (P = .03). QoL assessment revealed general satisfaction with postoperative outcomes and excellent physical and mental functioning. rPP for post-esophagectomy DGE is well-tolerated, results in improvements in symptoms and pharmacologic dependence, and satisfactorily preserves QoL.

Pyloric atresia: A report of ten patients

Pyloric atresia (PA) is uncommon. It occurs in 1:100000 live births. Neonates usually present soon after birth with copious non-bilious vomiting. The treatment is surgical and its prognosis is poor, especially, when it is associated with epidermolysis bullosa (EB). The aim of this study was to evaluate the clinical presentation, diagnosis, operative management, post-operative courses, and outcome in infant with PA, based in our cases and literature review. Charts of 10 patients who underwent surgery for PA in the department of paediatric surgery in a Teaching Hospital in Tunisia (Monastir) between 1990 and 2012 were reviewed. Data were analysed for demographic, clinical, therapeutic, and prognostic characteristics. The average of age at presentation was 2 days and there were six males and four females. The main presenting symptoms were non-bilious vomiting in 90% of cases. Abdominal X-ray showed gastric dilatation with an absence of gas in the rest of the intestinal tract in 90%, and a pneumoperitoneum in one. The surgical approach was laparotomy in all cases. Gastric perforation was observed in one patient and was completely repaired. The distribution of the anatomic variations was type A in nine cases and type B in one. Five patients underwent excision of the diaphragm and Heineke-Mikulicz pyloroplasty and gastroduodenostomy in the other five cases. Identified associated anomalies were Down's syndrome in one and EB in 2 (20%), one family has three affected sibling. Post-operative mortality rate was 70%. No standard surgical approach can be adopted a better management of PA or the associated anomalies depends on an early diagnosis and the availability of neonatal intensive care unit.

Minimally Invasive Pyloroplasty

A vagotomized, tubularized gastric conduit is the most commonly used conduit for reconstruction of the thoracic esophagus at esophagectomy. However, the gastric conduit is an imperfect esophageal replacement. The conduit has no receptive relaxation and has a reduced capacity compared with the native stomach. There is decreased antral motility, and gravity is the major determinant of conduit drainage. A pyloric drainage procedure, such as a pyloroplasty or pyloromyotomy, facilitates the emptying of the gastric conduit and may improve foregut function and quality of life after esophageal resection.1 Critics of this approach are concerned that a pyloroplasty may lead to excessive bile reflux and too rapid emptying of the stomach. At our institution, we have developed a minimally invasive Ivor Lewis esophagectomy to treat resectable cancer of the esophagus and gastroesophageal junction.2,3 To optimize conduit function and emptying, we construct a narrow, straight gastric conduit, 3-4 cm in diameter, and perform a pyloroplasty. Here, we describe a technique of minimally invasive, Heineke–Mikulicz pyloroplasty, which we routinely perform within the context of a minimally invasive, Ivor Lewis esophagectomy.

Pneumatic dilation in treatment of late-onset primary gastric outlet obstruction in childhood

Late-onset primary gastric outlet obstruction in childhood is a rare condition. Only 8 cases of such were reported. Diagnosis should be considered while ruling out mechanical and structural lesions. Up to now, Heineke-Mikulicz pyloroplasty has been the standard treatment. However, we succeeded in treating this condition by using pneumatic dilation. There is no sign of recurrence for 1 year. We propose the etiology, diagnosis, and the relationship between late-onset primary gastric outlet obstruction and esophageal achalasia in childhood.

Outcomes of pyloroplasty and pyloric dilatation in children diagnosed with nonobstructive delayed gastric emptying

Background Pyloroplasty and pyloric dilatation are methods used to ameliorate the symptoms of nonobstructive delayed gastric emptying in children. Our purpose was to review the results of these methods with respect to symptomatic improvements. Methods We retrospectively reviewed the records of children who, exclusive of fundoplications, in the 11-year period before December 31, 2005, had undergone at our institution a Heineke-Mikulicz pyloroplasty (HMP) and/or a fluoroscopically guided balloon pyloric dilatation (FGBD). We recorded evidence of either short- or long-term subjective improvement of symptoms. Results Twenty-three children underwent HMP. Five had no prior medical treatment. Of the 23, 3 had no subjective improvement in symptoms. Of the 20 who had subjective evidence of improvement recorded, 13 (56.5%) proved to be long-term and 7 short-term improvement. Eight children had FGBD. All 8 had prior medical treatment that had failed. There were 3 who displayed no subjective evidence of improvement, whereas 5 had subjective evidence of improvement—3 (37.5%) long term and 2 short term. Conclusions Heineke-Mikulicz pyloroplasty and FGBD in this study demonstrated only in limited numbers long-term improvement of symptoms. Efforts to understand more fully gastric emptying and to define those children who should undergo FGBD or HMP are needed.

Dumping symptoms after vagotomy treated by reversal of pyloroplasty.

Abstract Eight patients with intractable dumping symptoms following truncal vagotomy and Heineke–Mikulicz pyloroplasty for duodenal ulcer had the pyloroplasty reversed. These patients were assessed, both clinically and by a dumping provocation test, before operation, within 3 months of reversal of the pyloroplasty, and again at 1 year postoperatively. Six of them had no symptoms during the year and results of their dumping provocation tests have reverted to normal. Five have been followed up for a further year and in all the clinical improvement is maintained. Two patients developed recurrent dumping symptoms within 6 months of the reversal procedure.

The effect of vagotomy and drainage operations on the rate of gastric emptying in duodenal ulcer patients

Abstract The rate of gastric emptying was estimated in 29 patients with duodenal ulcers, before and after vagotomy and drainage operations, by measuring the disappearance from the stomach of a standard meal containing radioactive chromium. When Heineke-Mikulicz pyloroplasty accompanied vagotomy gastric emptying was observed to be slowed, whereas after vagotomy and Fitmey pyloroplasty the rate of gastric emptying was more rapid when compared with the preoperative rate. Gastric emptying after vagotomy and gastrojejunostomy showed no consistent alteration in rate. Temporary gastric stasis occurred in the early postoperative period after vagotomy and drainage procedures.

Rare causes of gastric outlet obstruction in children

Gastric outlet obstruction (GOO) presenting beyond the newborn period is a relatively rare condition, when infantile hypertrophic pyloric stenosis (IHPS) is excluded. This report describes the clinical features, evaluation and management of 18 patients with GOO which was not caused by IHPS. The sex, age, and main presenting features were recorded on admission. Hemoglobin estimation, serum chemistry and blood gas analysis were also assessed in these patients. The diagnosis was confirmed with gastrointestinal barium, B ultrasound, gastroscopy, or at surgery. Some of them underwent gastroscopy with biopsy sampling for rapid urease test or histologic examination with Giemsa stains for Helicobacter pylori. Thirteen patients had peptic ulcer disease, of which six were successfully treated with medications. While the other seven needed operative management which included Heineke-Mikulicz pyloroplasty, gastroduodenostomy or gastrojejunostomy, respectively. All the patients who had Heineke-Mikulicz pyloroplasty or gastrojejunostomy developed bile reflux gastritis that could be alleviated with omeprazol. None of the patients developed dumping syndrome, failing to thrive, or anemia. Three children with antral diaphragm recovered without any complications by diaphragm excision with Heineke-Mikulicz pyloroplasty. The pylorus was compressed by fibrotic band in one 30-month boy, and he recovered uneventfully with Heineke-Mikulicz pyloroplasty during 10-year follow-up. Gastric outlet obstruction secondary to ingestion of sulfuric acid was noted in one patient, and he was successfully treated with gastroduodenostomy. Our data suggests that the satisfactory results could be expected in children with GOO with different therapeutic modalities based on the specific cause and degree of obstruction.

Late-onset primary gastric outlet obstruction—an unusual cause of growth retardation

We describe our experience of 2 children and review 6 previously reported cases of late-onset primary gastric outlet obstruction. The patients presented with abdominal pain, recurrent nonbilious vomiting, and growth retardation after a variable period of normal food intake. There was no history of peptic ulceration and corrosive ingestion. Barium meal showed dilated stomach with delayed gastric emptying. Exploration demonstrated dilated stomach with no intrinsic or extrinsic mechanical obstruction at the pylorus. Heineke-Mikulicz pyloroplasty was curative. Patients improved postoperatively and started thriving. We propose etiology and the term pyloric achalasia for this late-onset functional gastric outlet obstruction.

Solid Gastric Emptying after Highly Selective Vagotomy and Pyloroplasty in Patients with Obstructing Duodenal Ulcer

Before being superseded by medical management, highly selective vagotomy (HSV) without drainage was the procedure of choice for uncomplicated duodenal ulcer. It is also justified for complications, including perforation and bleeding in selected cases. This prospective study evaluated the effects of HSV plus drainage on solid gastric emptying in 20 patients with chronic duodenal ulcer and pyloric stenosis. Patients were treated with HSV plus pyloroplasty (Heineke-Mikulicz pyloroplasty in five patients, Finney pyloroplasty in six patients and Jaboulay gastroduodenostomy in nine patients) and underwent solid-phase gastric emptying scintigraphic studies pre-operatively and 2 months and 6 months post-operatively. Results were compared with those from 10 controls. No significant differences were observed between the different types of pyloroplasty, although emptying was slightly faster in the gastroduodenostomy group. Gastric emptying returned to normal by 6 months post-operatively. In conclusion, HSV plus pyloroplasty is effective and can be used for the relief of stenosis in selected cases of duodenal ulcer.

COMPARISON OF THE EFFECT OF LAPAROSCOPIC AND CONVENTIONAL PYLORIC SURGERY ON GASTRIC EMPTYING IN DOGS

The effect of a laparoscopic approach and pyloric surgery on canine gastrointestinal activity, particularly gastric emptying time, is not well understood. The purpose of this study was to compare the effect of laparoscopic and conventional pyloric surgery, in Ramstedt pyloromyotomy and Heineke-Mikulicz pyloroplasty, on complete gastric emptying time in 20 clinically normal dogs. Dogs were divided into four groups of five animals: dogs with laparoscopic Ramstedt pyloromyotomy, conventional Ramstedt pyloromyotomy, or laparoscopic Heineke-Mikulicz pyloroplasty, and the conventional Heineke-Mikulicz pyloroplasty group. Gastric emptying time using barium sulfate mixed with dry kibble dog food was measured fluoroscopically before and 1 month after surgery. Gastric emptying of solids was significantly enhanced in the pyloroplasty groups in the postoperative period compared with preoperative emptying. Just as after conventional pyloromyotomy, gastric emptying time after laparoscopic pyloromyotomy was not statistically different as compared with preoperative values. This study indicates that the fluoroscopic test meal is a valuable tool for defining complete gastric emptying time in normal dogs. We conclude that pyloromyotomy was less effective in decreasing complete gastric emptying time than Heineke-Mikulicz pyloroplasty in normal dogs. The possibility of decreasing complete gastric emptying time by laparoscopic surgery suggests a potential clinical application for this technique in small animals.

P0748 SURGICAL INTERVENTION FOR DELAYED GASTRIC EMPTYING IN THE NON-HANDICAPPED CHILD

Introduction: Although chronic vomiting is a common presenting symptom in both the neurologically handicapped and non-handicapped child, a history pointing clearly to delayed gastric emptying is relatively rare. Investigations may suggest delayed gastric emptying with or without gastro-oesophageal reflux. Whether surgery should attempt to enhance gastric emptying without also correcting gastro-oesophageal reflux is debated. We present our experience of surgical intervention in this group of patients. Methods: This is a retrospective case note review of children without neurological handicap referred to a tertiary centre, who underwent a surgical procedure as treatment for delayed gastric emptying without any antireflux procedure. Results: Between January 1999 and December 2004 seven patients underwent a Heineke-Mikulicz pyloroplasty. They were aged between seven months and fourteen years and all presented with a history suggestive of delayed gastric emptying, confirmed by radio-isotope scan. All children failed to respond to prokinetic agents before undergoing surgery. Pyloroplasty was performed as an open procedure in the first three patients and laparoscopically in the other four. In six patients with follow-up of greater than eight months (range eight months to three years), all have improved although one child still vomits if a large meal is taken. The seventh child has only recently undergone the procedure but their results will be presented. Although the childen who underwent laparoscopic surgery did not achieve earlier discharge, pain relief and cosmetic results were improved. There were no surgical complications. Conclusion: We believe that pyloroplasty alone is a good operation for children with vomiting due to delayed gastric emptying. We would argue that the recognised complications following anti-reflux surgery (1) are such that, in a non-neurologically handicapped child, gastric emptying should be assessed and treated in isolation, if found to be abnormal.