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General Surgery


Answer 3
  1. Closure of the mucosal and muscular defects with repeat myotomy on another side of the pylorus. The most common technical complications of pyloromyotomy are mucosal perforation on the distal aspect of the incision and insufficient extent of myotomy on the proximal end. Injury to the mucosa is best managed by closure of the entire incision, rotation of the pylorus by 90 degrees, and repeat pyloromyotomy. While it is technically acceptable to close the myotomy and reoperate at a later date, this requires protracted parenteral nutrition, which increases the risk of other complications. Neither drainage nor extended antibiotics are indicated in this case.

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