What Is Pyloromyotomy?

Pyloromyotomy as stated is a surgical procedure, which is done to fix pyloric stenosis which
causes the food to get blocked in the stomach resulting in the stomach to be full always and
causing the baby to vomit after each feeding. This results in significant amount of loss of vital
electrolytes from the body creating an electrolyte imbalance. Before proceeding with
Pyloromyotomy, the treating team will make sure that all the electrolytes lost are replenished.
This is done intravenously. Once the electrolytes are adequately replenished then the baby is
taken to the OR for a pyloromyotomy.

What Are The Indications For Pyloromyotomy?

A pyloromyotomy procedure is indicated when there is a confirmed diagnosis of a Pyloric

Stenosis. In Pyloric Stenosis, the baby will have the following symptoms:

 Frequent vomiting after feeds

 Excessive irritability
 Less voiding and passing of stools
 No significant weight changes

How Is Pyloromyotomy Procedure Done?

After successful induction of anesthesia by the anesthesiologist, the surgeon then inserts an
instrument through a small incision called a laparoscope to look at the thickened muscles of the
pylorus. An instrument is then inserted through the laparoscope in order to separate the
thickened muscles of the pylorus and thus creating an opening for the food to pass freely. The
approximate time taken for the surgery is about half hour. After successful completion of the
procedure, the infant is then taken to the Postanesthesia Care unit or the PACU for observation.

Pyloromyotomy Complications

Pyloromyotomy is considered safe and curative surgical procedure. The mortality and morbidity
rate associated with Pyloromyotomy procedure are very less i.e. less than 0.5 % and less than
10 % respectively. But there are also some complications associated with this procedure. The
most common complication seen is duodenal perforation. Intubation may also be difficult
being a complication, so it require prolong ventilation. These complications are intra operative
complications.

Some post-operative complications are as follows.

 Vomiting may occur and there are rare chances of sepsis due to Hirsch sprung disease. 
 Adhesion and Bowel obstructions can also occur after surgery.
Pyloromyotomy Side effects

      
In Pyloromyotomy, the most common side effects seen is vomiting. The patient may vomit right
after surgery and may continue vomiting till 24 hours pass. This is because, the gastrointestinal
tract may not accept the changes made to the pylorus and the reflex action occurs resulting in
vomiting. The vomiting may be the side effect of pyloric stenosis. The stones in the pyloric end
make the way block which transfer food to intestine and as a result, vomiting may occur.
Pyloromyotomy make the opening of pyloric end of stomach wide in order to pass the food to
intestine.

Pyloromyotomy Risks:

Your baby may bleed more than expected or get an infection. Your baby could develop
pneumonia. His or her stomach, intestines, or other nearby organs may be damaged. The
pylorus muscle could grow thick again and block your baby's intestines. Your baby may need
surgery again.

Before your baby's surgery:

 Informed consent is a legal document that explains the tests, treatments, or procedures
that your child may need. Informed consent means you understand what will be done
and can make decisions about what you want. You give your permission when you sign
the consent form. You can have someone sign this form for you if you are not able to
sign it. You have the right to understand your child's medical care in words you know.
Before you sign the consent form, understand the risks and benefits of what will be done
to your child. Make sure all of your questions are answered.
 An IV is a small tube placed in your baby's vein that is used to give medicine or liquids.
 General anesthesia will keep your baby asleep and free from pain during surgery.
Anesthesia may be given through your baby's IV. He or she may instead breathe it in
through a mask or a tube placed down his or her throat. The tube may cause your baby
to have a sore throat when he or she wakes up.

During your baby's surgery:

 Your baby's surgeon will make small incisions in your baby's abdomen. He or she may
make an incision in your baby's belly button. The surgeon will cut the thick, tight pylorus
muscle and spread it apart so food can pass through. He or she will close the incision
with stitches or medical tape.

After your baby's surgery:

Your baby will be taken to a room to rest until he or she is fully awake. Healthcare providers will
monitor your baby closely for any problems. He or she will then be able to go home or be taken
to his or her hospital room.
  Intake and output may be measured. Healthcare providers will keep track of the
amount of liquid your baby is getting. They also may need to know how much your baby
is urinating. Ask healthcare providers if they need to measure or collect your baby's
diapers.
 Your baby's weight will be checked each day.
 Breast milk, formula, or other liquid will be given to your baby slowly. He or she may
be given sugar water or water with electrolytes first. Then he or she will get diluted
breast milk or formula. If your baby's stomach does not become upset, he or she may
then be able to start feeding normally.
 A nasogastric (NG) tube may still be in place after surgery for the first 2 or 3 feedings.
This is so healthcare providers can see if there is formula or breast milk left in the
stomach after your baby feeds. Once your baby is feeding well, the NG tube will be
removed.
 Your baby may vomit a few times for the first 2 or 3 days after surgery. This may be
caused by swelling around the surgery area and should get better.
 Medicines may be given to manage your baby's pain or to prevent an infection caused
by bacteria.

Pyloromyotomy Care

In Pyloromyotomy, care should be taken during or after surgery. During Pyloromyotomy surgery,
care should be taken while making an incision and bulging the mucosal lining out. The mucosa
should not be injured that’s why extra care is required. The sutures used should be sterile. And
after surgery the patient should be shifted to post anesthesia care unit which is abbreviated as
PACU or the recovery room. The patient will stay there until he wake up and should be under
complete observation. The visitors can meet him when he woke up after the effect of anesthesia
diminishes.