Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis secondary to gastro‐duodenal ulcer disease in three foals

Abstract

Summary The objective of the study was to describe a modified Heineke–Mikulicz pyloroplasty for the treatment of pyloric stenosis in foals due to gastric ulceration and assess the short‐ and long‐term outcome of foals receiving the pyloroplasty. Medical records of foals undergoing a modified Heineke–Mikulicz pyloroplasty due to gastric outflow obstruction secondary to a pyloric stenosis were included in this retrospective case series. The pyloroplasty consisted of an oral to aboral full thickness longitudinal incision on the ventral aspect of the pylorus and proximal duodenum, which was sutured closed with 0 polydioxanone in a transverse orientation, thereby, enlarging the pyloric lumen diameter. Long‐term outcome was obtained from medical and race records. The pyloroplasty was successfully performed in three foals with a surgical time of 95–121 min, with immediate return to nursing and hospital stay of 4–14 days. Complications included a small intestinal volvulus and intra‐abdominal adhesions in a foal that did not survive. Another foal had an incisional infection. Two of the three foals went on to race. It was concluded that the pyloroplasty procedure is an acceptable option for the treatment of pyloric stenosis and secondary gastric outflow obstruction due to gastric ulceration. The limited amount of bowel manipulation with no change in intestinal flow, along with the successful outcomes achieved, make this another surgical option available for the correction of pyloric stenosis in foals.

Squamous gastric ulceration complicated by gastric stenosis in a foal

“…It was considered unlikely that medical management of the current case would result in the foal being able to lead a normal life and consume a normal diet. Gastric bypass procedures, such as gastroduodenostomy or gastrojejunostomy, or pyloroplasty have been described in foals suffering strictures at the level of the duodenum, but these would not have provided relief in the present case, since the pyloric region was not affected (Kent et al., 2020; Zedler et al., 2009). Creating a bypass above the level of the stricture would have resulted in a very small functional stomach and feed not being able to pass through the glandular fundus.…”

“…Various surgical techniques have been described for cases of gastroduodenal ulcer disease (GDUD) that fail to respond to medical treatment (Zedler et al., 2009). The procedures are reported to be associated with an excellent prognosis for foals with pyloric obstruction (Kent et al., 2020) and a fair to guarded prognosis for foals with duodenal obstruction (Zedler et al., 2009).…”