What is Pyloromyotomy

Pyloromyotomy is a procedure that loosens the opening between the stomach and the small intestine (pylorus).

This is done to treat a condition in which the pylorus thickens and narrows, which then keeps food from passing through the stomach (pyloric stenosis).

This causes repeated vomiting, which can lead to dehydration and malnutrition. Pyloric stenosis is usually found in infants.

This procedure may be done in one of the following ways:

• Laparoscopic surgery. This procedure is typically done through three small incisions in the abdomen. A thin tube with a light and camera (laparoscope) is used to perform the procedure. Images from the laparoscope are shown on a screen, which allows the surgeon to operate without having to make a larger incision.
• Open surgery. During this procedure, the pylorus is accessed through a larger incision in the abdomen.

Tell a health care provider about:

• Any allergies your child has.
• All medicines your child is taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems your child or family members have had with anesthetic medicines.
• Any blood disorders your child has.
• Any surgeries your child has had.
• Any medical conditions your child has.

What are the risks?

Generally, this is a safe procedure. However, problems may occur, including:

• Infection.
• Bleeding.
• Allergic reactions to medicines or dyes.
• Damage to other structures or organs, such as a hole (perforation) in the stomach or the first part of the small intestine (duodenum).
• Vomiting.

What happens before the procedure?

• Follow instructions from your child’s health care provider about eating or drinking restrictions.
• Your child will be given fluids and nutrients through an IV until he or she is healthy enough for surgery.
• Your child may have tests done, such as:
  • Blood tests.
  • Imaging tests, such as an ultrasound or X-ray.
• Your child may be given antibiotic medicine to help prevent infection.
• Ask your child’s health care provider how the surgical site will be marked or identified.

What happens during the procedure?

• To lower your child’s risk of infection:
  • Your child’s health care team will wash or sanitize their hands.
  • Your child’s skin will be washed with soap.
• An IV will be inserted into one of your child’s veins.
• Your child will be given one or more of the following:
  • A medicine to help him or her relax (sedative).
  • A medicine to numb the area (local anesthetic).
  • A medicine to make him or her fall asleep (general anesthetic).
• If your child is having open surgery:
  • An incision will be made near the top of the stomach or over the belly button.
  • Tissue and muscle will be moved out of the way to allow access to the pylorus.
• If your child is having laparoscopic surgery:
  • An incision will be made in the belly button. Two small incisions may also be made on the left and right side of the stomach.
  • A laparoscope and other surgical tools will be passed through the incisions to perform the procedure. A tool called a grasper will be used to grab the pylorus.
• An incision will be made in the pylorus.
• The pylorus muscle will be spread apart.
• The stomach will be filled with air. This will test for any leaks in the pylorus.
• The incisions in the abdomen will be closed with stitches (sutures) and covered with a bandage (dressing).

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• Your child’s blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored until the medicines have worn off.
• Your child’s health care providers will try to feed your child a few hours after the procedure. Children are typically fed a liquid containing salts and minerals (electrolytes), and formula or breast milk.

Summary

• Pyloromyotomy is a procedure that loosens the opening between the stomach and the small intestine (pylorus).
• This procedure may be performed with open surgery or laparoscopic surgery.
• Your child will receive fluids and nutrients until he or she is healthy enough for surgery.

Pyloromyotomy, Pediatric, Care After

This sheet gives you information about how to care for your child after the procedure. Your child’s health care provider may also give you more specific instructions. If you have problems or questions, contact your child’s health care provider.

What can I expect after the procedure?

After the procedure, it is common for your child to have:

• Vomiting after eating. This may happen for the first 2 days after the procedure.
• Pain and tenderness in the incision area.

Follow these instructions at home:

Eating and drinking

• Feed your child according to the schedule given to you by your child’s health care provider. Your child’s health care provider may recommend feeding your child formula or breast milk, as well as a fluid that contains salts and minerals (electrolytes).

Medicines

• Give over-the-counter and prescription medicines only as told by your child’s health care provider.
• Do not give your child aspirin because of the association with Reye syndrome.

Incision care

• Follow instructions from your health care provider about how to take care of your child’s incisions. Make sure you:
  • Wash your hands with soap and water before you change your child’s bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your child’s dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your child’s health care provider tells you to do that.
• Check your child’s incisions every day for signs of infection. Check for:
  • Redness, swelling, or signs that your child is having more pain.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.

General instructions

• Change wet or dirty diapers as soon as possible. This can help prevent infection.
• Keep track of how much stool and urine your child passes. This may involve weighing your child’s diapers and recording the weight. If you notice any significant changes to the output, contact your health care provider.
• Keep all follow-up visits as told by your child’s health care provider. This is important.

Contact a health care provider if:

• Your child vomits after eating more than 2 days after the procedure.
• Your child develops new or worse symptoms.
• Your child’s incision has signs of infection, such as:
  • Redness or swelling.
  • Fluid or blood.
  • Warmth.
  • Pus or a bad smell.
• Your child seems to have more incision pain instead of less.
• Your child is urinating less often than usual.
• Your child has fewer bowel movements than usual.
• Your child loses weight.
• Your child has a fever.

Get help right away if:

• Your child who is younger than 3 months has a temperature of 100°F (38°C) or higher.
• Your child shows signs of dehydration, such as:
  • Little or no urine.
  • Dry mouth or lips.
  • Little or no tears.
  • Irritability.
  • Fatigue.
• Your child’s skin or the whites of the eyes turn yellow (jaundice).

Summary

• For the first 2 days after the procedure, your child may vomit after eating. If your child continues to vomit more than 2 days after the procedure, contact your child’s health care provider.
• Feed your child according to the schedule given to you by your child’s health care provider.
• Change wet or dirty diapers as soon as possible. This will help prevent infection.
• Get help right away if your child has a high fever or signs of dehydration.