Laparoscopic vagotomy with gastrojejunostomy for corrosive pyloric strictures.

Sir,

We read with interest the recent article “Pyloric and antral strictures following corrosive acid ingestion” by Shukla et al.[1]

Gastrojejunostomy has been suggested as the treatment of pyloric stricture secondary to corrosive injury.[2] Laparoscopic approach is better than open because of lesser blood loss, lesser morbidity, and early recovery.[3] Postoperative stay of the patient in the hospital is reduced. There is also a reduced incidence of wound site infection.

We do a laparoscopic truncal vagotomy [Figure 1] with gastrojejunostomy for such patients as there is a significant risk of development of stomal ulcers if vagotomy is not done along with gastrojejunostomy.[4] There have been suggestions that the corrosive would have destroyed the acid producing cells, but no evidence to this effect has been shown in any scientific study.[5]

Figure 1

Laparoscopic vagotomy

We recently had a 15-year-old female with a history of toilet cleaner (acid) ingestion. She had been treated conservatively with gastric lavage and was subsequently discharged with no complications. After 1 month of this episode, she presented to our hospital with recurrent vomitings which was initially to solids and later progressed to liquids. The patient had 7 kg weight loss in a month and was nutritionally depleted. An upper GI endoscopy showed narrowing at pylorus with a normal esophagus. This is consistent with the “licks the esophagus and bites the pylorus” hypothesis.[1] This patient underwent a laparoscopic vagotomy with gastrojejunostomy and made a rapid recovery.

We would like to suggest that these patients should be offered a laparoscopic gastrojejunostomy for all the benefits of minimal access surgery and a vagotomy should be added to avoid the delayed complication of stomal ulceration.