Pyloric exclusion. Suture material of choice.

Pyloric exclusion was first reported in 1977 as a temporary method of providing duodenal decompression in an attempt to protect the duodenum in the early postoperative period during the healing phase, followed by the return of normal gastrointestinal transit. It has been adopted by several trauma centers across the country as part of their armamentarium for managing moderate to severe duodenal injuries. Most series report using a polyglycolic acid (PGA) suture in performing the exclusion, anticipating a 3- to 4-week interval before pyloric patency is re-established. A comparison of polypropylene (PP), polyglycolic acid (PGA), and polydioxanone (PDS) sutures in the dog model suggests, however, that only PDS reliably accomplishes this goal. The low (approximately 5-10%) but finite incidence of fistula formation reported with pyloric exclusion using PGA may be improved by using PDS instead.