Skip to Main Content

Chapter 46. Operative Management of Pyloric Stenosis: Pyloromyotomy

Benjamin Levi, MD; George B. Mychaliska, MD

  • Projectile nonbilious emesis in an infant.
  • Palpable "olive" on physical examination.
  • "String sign" on an upper gastrointestinal series.
  • Pyloric muscle wall thickness ≥ 4 mm and pyloric channel length ≥ 16 mm on ultrasound examination.

  • Severe hypochloremic, hypokalemic metabolic alkalosis.
  • Severe dehydration.

  • For both open and laparoscopic procedures, the infant should be supine on the operating table.
  • Laparoscopic procedure.
    • The infant is positioned supine at the end of the operating table with appropriate padding.
    • The lower extremities are secured to the operating table in a frog leg position.

  • Maintenance intravenous fluids are given until the infant is able to tolerate oral feedings.
  • Nothing by mouth for 6 hours followed by feeding every 3 hours:
    • For the first feeding, give 30 mL of full-strength formula; for the second feeding, give 60 mL of formula, and then increase amount as tolerated.
  • If the infant vomits, hold feeding and repeat the last tolerated volume in 3 hours.

  • Mucosal perforation.
  • Incomplete myotomy.
  • Wound infection.

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.

This site uses cookies to provide, maintain and improve your experience. MH Privacy Center Close