{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T18:06:44Z","timestamp":1785434804055,"version":"3.56.0"},"reference-count":16,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["The American Surgeon\u2122"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pyloric exclusion (PEX) was initially described for duodenal fistula and complex ulcer disease. It was adopted in trauma surgery as an adjunct to primary repair of complicated duodenal injuries. However, its use in the non-trauma population has remained uninvestigated in recent years. Its current role as a highly selective operation for complex duodenal pathology remains ambiguous in the acute care surgery population. The aim of this study was to assess indications and outcomes of PEX in the acute care surgery population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients that underwent pyloric exclusion in the NSQIP database between 2005 and 2021 were identified. Risk factors and outcomes were also extracted. Univariate logistic regression (LR) analysis was used to compare outcomes by surgical indication. Multivariate LR analysis adjusting for timing of operation (emergent vs non-emergent), age, and medical comorbidity was also used to compare outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      117 patients were identified during the study period. The most common indication for PEX was ulcer (n = 32, 50.8%) and neoplastic disease (n = 24, 22.4%). Pyloric exclusion was performed emergently 84.4% of the time for ulcers and 8.3% of the time for neoplastic disease. On univariate analysis, complications were more common for ulcer vs neoplastic disease [71.9% vs 33.3%, OR = 5.11 (95% CI: 1.6-16.1),\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01] and for emergent vs non-emergent surgery [69.4% vs 45.9%, OR = 2.67 (95% CI: 5.9-1.2),\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.01]; however, this was not re-demonstrated on multivariate analysis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Pyloric exclusion is rarely performed in acute care surgery. It is most often performed for ulcer and neoplastic pathology, with outcomes dependent on clinical urgency.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00031348261472866","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T07:14:47Z","timestamp":1785222887000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Pyloric Exclusion in Modern Acute Care Surgery: A Selective Salvage Strategy for Complex Duodenal Pathology"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4507-0507","authenticated-orcid":false,"suffix":"II","given":"Mohammed I.","family":"Ranavaya","sequence":"first","affiliation":[{"name":"UofL Health,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinweotuto Vee","family":"Uma","sequence":"additional","affiliation":[{"name":"UofL Health,"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Badach","sequence":"additional","affiliation":[{"name":"Department of Surgery, St. Joseph\u2019s University Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Smith","sequence":"additional","affiliation":[{"name":"UofL Health,"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,28]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-190405000-00010"},{"key":"e_1_3_4_3_2","first-page":"379","article-title":"Pyloric exclusion an experimental and clinical study by Richard Lewisohn, MD, New York City","volume":"2","author":"Lewisohn R","year":"1912","unstructured":"Lewisohn R. Pyloric exclusion an experimental and clinical study by Richard Lewisohn, MD, New York City. Studies from the Laboratories: V 1-4. 1912;2:379-388.","journal-title":"Studies from the Laboratories: V 1-4"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-191805000-00007"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0002-9610(32)90921-0"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9610(77)90325-7"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1177\/000313480807401009"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1097\/ta.0000000000003972"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318033a790"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-193610440-00020"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-190705000-00009"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-199301000-00013"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1590\/s1516-31802008000600009"},{"issue":"12","key":"e_1_3_4_14_2","first-page":"711","article-title":"Pyloric exclusion. Suture material of choice","volume":"53","author":"DeSantis M","year":"1987","unstructured":"DeSantis M, Devereux DF, Thompson D. Pyloric exclusion. Suture material of choice. Am Surg. 1987;53(12):711-714.","journal-title":"Am Surg"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.vgie.2022.11.009"},{"key":"e_1_3_4_16_2","volume-title":"StatPearls","author":"Sigmon DF","year":"2025","unstructured":"Sigmon DF, Lopez PP. Gastrojejunostomy. In: StatPearls. StatPearls Publishing LLC, StatPearls Publishing Copyright \u00a9 2025; 2025."},{"key":"e_1_3_4_17_2","doi-asserted-by":"publisher","DOI":"10.1097\/mlr.0000000000001733"}],"container-title":["The American Surgeon\u2122"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261472866","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/00031348261472866","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/00031348261472866","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T17:46:51Z","timestamp":1785433611000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/00031348261472866"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,28]]},"references-count":16,"alternative-id":["10.1177\/00031348261472866"],"URL":"https:\/\/doi.org\/10.1177\/00031348261472866","relation":{},"ISSN":["0003-1348","1555-9823"],"issn-type":[{"value":"0003-1348","type":"print"},{"value":"1555-9823","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,28]]},"article-number":"00031348261472866"}}