Chapter 10: Table of Contents
A 3 to 4cm long, longitudinal, partial thickness incision is made in the serosamuscular layers of the pyloric antrum. The pyloric incision should be centered half way between the greater and lesser curvature vessels. Do not incise too close to the pylorus as this could lead to postoperative gastric emptying issues. In the area of the proposed incision, pinch the pyloric antrum between your thumb and index finger and slowly lift the tissues, you will feel the mucosa distinctly slip out of your grip and will be left with the seromuscular layers between your fingers; this is a simple way to assess how deep your pyloric antrum incision will need to be. Ensure that you cut deep enough to see the submucosa bulge through the incision allowing the seromuscular edges to separate. Inadvertent incision through the mucosa can be sutured with a simple interrupted or cruciate suture (size 3-0 absorbable).