Combined use of electrosurgical incisions and balloon dilatation for the treatment of refractory postoperative pyloric stenosis

BACKGROUND: Drug therapy plus balloon dilatation without gastroscopic incision does not always relieve postoperative pyloric stenosis. METHODS: Five patients with postoperative pyloric stenosis whose symptoms did not improve with drug therapy and balloon dilatation underwent a combination of gastroscopic incision and balloon dilatation. Two or 3 small radial incisions were made in the stenotic muscle of the pylorus electrosurgically at gastroscopy. Then the stenotic muscle layer was loosened and split bluntly along the incisions with balloon dilatation for 15 to 20 minutes. One week later, the combination procedure or balloon dilatation alone was repeated to prevent restenosis. RESULTS: In the 5 patients, the stenosis was improved with the combination therapy. No complications were observed. CONCLUSIONS: Combined use of gastroscopic incision and balloon dilatation may be considered for patients with refractory pyloric stenosis caused by surgical truncal vagotomy.