Pyloroplasty in Cats

Pyloroplasty is a surgical procedure used to treat gastric dilatation and pyloric stenosis. Pyloroplasty involves widening the pyloric lumen, the tube which connects the stomach to the duodenum in the small intestine. There are two types of pyloroplasty: Heineke-Mikulicz pyloroplasty and Y-U pyloroplasty. Surgeons prefer to use the Y-U pyloroplasty technique because it carries a decreased risk of postoperative complications. 

There are only minor differences between the Heineke-Mikulicz and Y-U methods, largely to do with the style of incision. Since most surgeons prefer the Y-U method, this procedure will be discussed below.

1. The cat will first be treated for hypovolemic shock.
2. Once the cat is in a stable condition, it will then be anesthetized.
3. The surgeon will make the entry incision, isolating the surgical site with sponges.
4. Throughout the surgery, local lavage will be performed to decrease the risk of contamination.
5. The surgeon will then insert one or more stay suture(s) so forceps aren’t required to handle delicate tissue.
6. The surgeon will make three full-thickness incisions in the shape of a “Y” using a scalpel or small surgical scissors.
7. Once the gastric outflow obstruction has been resolved and the pyloric lumen has been widened, the “Y” will then be closed with sutures.
8. Before the stomach is closed with sutures, the surgeon will ensure the lumen is wider or more open than it was before operating.
9. The stomach will then be closed.
10. The surgeon will remove the stay sutures and perform one final check to ensure no leakage has occurred.
11. The vet will then remove the sponges before closing the initial site.

There is not much information in current veterinary literature on the efficacy of the procedure due to the rarity of the condition. However, this does not indicate that the procedure is unsuccessful. While there are risks involved, pyloroplasty may help correct pyloric stenosis, particularly in cases which medical treatment has failed to do so.

The cat may be hospitalized until it is in a more stable condition. Intravenous fluid and nutritional therapy will usually be required to correct fluid and nutritional imbalances. On the return home, the cat should not be fed for twelve to twenty-four hours or as instructed by the surgeon. Small meals should be fed for up to fourteen days following surgery as instructed. Anti-emetic drugs may be prescribed if vomiting is present.

The cat should not be allowed to irritate the surgery site, and should not engage in activity during the recovery period. The owner should check the surgery site daily to ensure swelling or drainage has not occurred. In the event that swelling or drainage occurs, or if the condition itself recurs, the owner should contact their trusted veterinary professional immediately.

The cost of pyloroplasty may vary depending on whether or not the owner incurs additional hospitalization, medication, and laboratory costs. On average, the cost of pyloroplasty can range from $1,500 to $5,000.

While pyloroplasty can treat gastric outflow obstruction in cases where medical management is insufficient, there are certain risks associated with the procedure. If a malfunction occurs during the procedure, it can prove difficult to correct and may require a second surgery. If the incision site ruptures, necrosis can occur, which can be life-threatening for the cat. Pyloroplasty is a delicate procedure which should be performed by an expert. There is a chance that the condition can recur even with surgery.

Since the condition is very rare in cats, prevention can be difficult. If the obstruction is a foreign body that the cat ingested, owners should ensure they monitor their cat to ensure they do not ingest items that can obstruct the gastrointestinal tract. Owners should ensure their cats receive adequate nutrition. Owners should not breed intact female cats that have been treated for pyloric stenosis.