Pyloromyotomy

Abstract

Hypertrophic pyloric stenosis (HPS) is one of the most common surgical diseases associated with vomiting in infants. Vomiting is due to obstruction caused by hypertrophy of the muscular layers of the pylorus. Most patients present with nonbilious projectile vomiting with associated dehydration and metabolic alkalosis. The hypertrophied pylorus, known as an “olive,” is palpable in the upper abdomen in most cases. Ultrasonography is the standard diagnostic test for HPS. Although there are reports of medical therapy with atropine, HPS is generally treated with surgery because atropine therapy requires a long hospitalization and is sometimes ineffective. Ramstedt’s pyloromyotomy is currently the standard treatment for HPS. Although an open surgery provides a large operative field, which makes the procedure safe and easy, laparoscopic pyloromyotomy has grown in popularity recently. Its popularity is due to several benefits including better cosmesis, faster recovery with earlier return to full feeding, and shorter length of hospital stay compared with an open procedure. In addition, there are several reports showing no difference in complication rate between open and laparoscopic procedures. We describe the technique of pyloromyotomy using the open procedure as well as the laparoscopic procedure.

The figures in this chapter are reprinted with permission from Standard Pediatric Operative Surgery (in Japanese), Medical View Co., Ltd., 2013, with the exception of occasional newly added figures that may appear.