Pyloromyotomy is a surgical procedure done on infants who are suffering from pyloric stenosis. Pyloric stenosis occurs when the muscle surrounding the lower opening of the stomach gets too large and constricts the opening. This opening is known as the pylorus, and constriction of the opening can prevent the contents of the stomach from passing into the small intestine.
Pyloric stenosis is most often diagnosed in infants who are three to five months old. It seems to be more common in males than females. The cause is unknown, but it may be inherited from a parent who suffered from the disorder. Symptoms of pyloric stenosis are forceful vomiting, dehydration, and constant hunger. These symptoms should not be ignored, as this disorder can be very serious.
A physician will need a history of vomiting and other symptoms to aid in making the diagnosis. Upon physical examination of the infant, the physician may feel the enlarged muscle at the base of the stomach. It will feel like a small knot in the abdomen. If pyloric stenosis is detected, a pyloromyotomy is usually recommended.
Prior to scheduling the pyloromyotomy surgery, the physician may schedule the infant for an ultrasound exam to get a view of the stomach. X-rays may also be taken in which the infant will need to drink a contrast dye that will show the blockage at the base of the stomach. Sometimes, contractions of the abdomen are visible as the stomach tries to push food out into the small intestine. Once the diagnosis is confirmed, the surgery is usually scheduled quickly afterward.
To prepare the infant for surgery, fluids must first be given intravenously to correct for any dehydration that has occurred. The pyloromyotomy procedure is done while the infant is under general anesthesia. It can be done as an open surgery or as a laparoscopic procedure.
For the open procedure, a small incision is made in the abdomen. The surgeon locates the base of the stomach and makes one cut in the muscle surrounding the pylorus. This opens the muscle and allows the opening at the base of the stomach to expand so that food can pass through to the small intestine.
Laparoscopic pyloromyotomy is more common, and involves the insertion of a camera and surgical instruments through three or four small incisions in the abdomen. As in an open procedure, a cut is made in the muscle surrounding the pylorus to expand the opening of the stomach. Recovery from the laparoscopic procedure should be shorter because the incisions are smaller.
Small amounts of food can be given to the infant several hours after surgery. There may be some vomiting after surgery, but this should stop within a day. If the parent notices that the symptoms continue for several days or that there are signs of infection, a physician should be consulted immediately.