Pyloromyotomy-The treatment of stenosis of pyloric

sphincter
Susan Powell-Proctor
NSG 4053
(Medindia.net, 2021)
 OVERVIEW OF TOPIC AND REASON FOR SELECTION

Pyloromyotomy is one of the rarest procedures requiring strict conformity to nursing plan for
the affected patients. The process refers to a surgical procedure involving making of an
incision in the circular and longitudinal muscles the pylorus. This special procedure is used in
treating hypertrophic pyloric stenosis. During the process, hypertrophied muscle is incised
along the whole length to a point when the mucosa bulges out.
This presentation explores pyloromyotomy through a critique of a research article exploring
postoperative outcomes of open versus laparoscopic pyloromyotomy for the management of
hypertrophic pyloric stenosis (HPS).
The work of Costanzo et al (2018) noted that Hypertrophic pyloric stenosis (HPS) is one of
the most common clinical indications for non-elective surgery within the neonatal population.
Several studies indicate that postoperative outcomes for open pyloromyotomy and
laparoscopic are almost similar. The study relied on data extracted from a prospective national
database to perform a comparison of postoperative complications as well as length of stay
(LOS) for infants subjected to laparoscopic versus open pyloromyotomy for the management
of hypertrophic pyloric stenosis.
Costanzo et al (2018) demonstrated that post-operative outcomes after laparoscopic
pyloromyotomy are similar or superior to outcome from an open approach. The implication is
that pyloromyotomy, a minimally invasive approach, is safe and more viable option for the
treatment of infantile hypertrophic pyloric stenosis (HPS).
RELEVANCE OF TOPIC TO NURSING
 Evidence suggest that pyloric stenosis is a problem that affects infants between birth
and 6 years old, causing forceful vomiting that leads to dehydration.
 The condition is also one of the most common surgical condition in newborn babies.
This means that all nurses working in pediatric units should understand its
management as a matter of principle.
 Nurses, as major link in healthcare delivery, play a critical role in the delivery of
quality and coordinated care, and optimization of health service productivity for the
sake of improving patient outcomes (Oldland et al, 2020). Nursing responsibility in
healthcare quality is what informs the clinical relevance of their knowledge in the
management of the second most common condition that causes surgery in infants.
 The responsibility of nurses in healthcare quality goes beyond the provision of safe
care that aligns with best practice. Nurses in pediatric units have a professional
mandate to monitor, measure and report on the effectiveness and appropriateness
of healthcare processes-thereby improving healthcare quality.
 The management of pyloric stenosis is therefore, of critical importance to nursing
profession as it affects one of the most vulnerable population in the entire healthcare
ecosystem-infants.
IMPACT OF TOPIC ON DELIVERING NURSING CARE-NEED FOR CLINICAL PRACTICE TO BE
CHANGED

 There is need for existing nursing practices surrounding pyloromyotomy to be

changed.
 Evidence suggests that cases of misdiagnosis of this condition at the clinical level
are on the rise
 Changes in practice should revolve around adoption of more pronounced and more
accurate diagnostic regimes.
 Additionally, evidence suggests the need to streamline existing nursing diagnoses,
nursing care planning and goals, nursing interventions, and evaluation processes.
 Nurses should be trained on improved care and management of pyloromyotomy to
reduce instances of post operative pyloromyotomy complications.
 One of the risks of pyloromyotomy is post-operative complications.
 Nursing practice should be changed to include more recent evidence-based
protocols for managing post-operative complications including the use of
standardized models of care.
 As noted by Clayton et al (2015), the implementation of postoperative care protocol
improved various aspects of patient care and nursing care leads to effective
communication among care providers leading to expedited recovery, reduce length
of stay, and enhanced patient care.
IMPACT OF TOPIC ON DELIVERING NURSING CARE-NEED FOR CLINICAL PRACTICE TO BE
CHANGED…CONTD

 The focus of nursing practice change should be on the optimization of

post-operative feeding regime.
 Generally, patients who have undergone surgical treatment of pyloric
stenosis (pyloromyotomy) experience and excellent recovery process
with minimal long-term effects. Post-operative feeding regimen for
infants usually involves feeding of special fluids for or two feedings
followed by breast milk/formula within a period of 24 hours.
 As noted by Acker et al (2015) recent evidence suggest that progress
has been achieved in the care of infants with hypertrophic pyloric
stenosis. Such progress includes the use of earlier operative
interventions & shorter hospital length of stay (LOS)-all of these
attributed to expedited feeding protocols developed by surgeons but
implemented by nurses. Studies have shown that HPS patients
admitted to units that are co-managed by nonsurgeons (nurses)
providers postoperatively have longer LOS that in standard surgical
wards. The implication is that nurses in pyloromyotomy should be
supervised by surgeons for improved standard of care to be achieved.
 SUMMARY OF WHAT CURRENT LITERATURE SAYS ABOUT THE TOPIC

 Recent literature suggests that post-operative outcomes after laparoscopic

pyloromyotomy are similar or superior to outcome from an open approach.
The implication is that pyloromyotomy, a minimally invasive approach, is
safe and more viable option for the treatment of infantile hypertrophic pyloric
stenosis (HPS) (Staerkle et al, 2021).
 It has also been established that laparoscopic pyloromyotomy may result in
minimal increase in mucosal perforation when compared with open
pyloromyotomy for infantile hypertrophic pyloric stenosis.
 There may be an also be an increased risk of incomplete pyloromyotomy
following laparoscopic pyloromyotomy compared with OP, but the effect
estimate could be inaccurate and includes the possibility of no difference
 SUMMARY

 The focus of nursing practice change should be on the optimization of post-

operative feeding regime.
 Generally, patients who have undergone surgical treatment of pyloric stenosis
(pyloromyotomy) experience and excellent recovery process with minimal long-
term effects. Post-operative feeding regimen for infants usually involves feeding
of special fluids for or two feedings followed by breast milk/formula within a
period of 24 hours.
 As noted by Acker et al (2015) recent evidence suggest that progress has been
achieved in the care of infants with hypertrophic pyloric stenosis. Such progress
includes the use of earlier operative interventions & shorter hospital length of
stay (LOS)-all of these attributed to expedited feeding protocols developed by
surgeons but implemented by nurses. Studies have shown that HPS patients
admitted to units that are co-managed by non-surgeons (nurses) providers
postoperatively have longer LOS that in standard surgical wards. The
implication is that nurses in pyloromyotomy should be supervised by surgeons
for improved standard of care to be achieved.
 SUMMARY

 Pyloromyotomy is one of the rarest procedures requiring strict conformity to

nursing plan for the affected patients. The process refers to a surgical
procedure involving making of an incision in the circular and longitudinal
muscles the pylorus. This special procedure is used in treating hypertrophic
pyloric stenosis. During the process, hypertrophied muscle is incised along the
whole length to a point when the mucosa bulges out.
 This presentation explores pyloromyotomy through a critique of a research
article exploring postoperative outcomes of open versus laparoscopic
pyloromyotomy for the management of hypertrophic pyloric stenosis (HPS).
 The work of Costanzo et al (2018) noted that Hypertrophic pyloric
stenosis (HPS) is one of the most common clinical indications for non-elective
surgery within the neonatal population. Several studies indicate that
postoperative outcomes for open pyloromytomy and laparoscopic are almost
similar. The study relied on data extracted from a prospective national database
to perform a comparison of postoperative complications as well as length of
stay (LOS) for infants subjected to laparoscopic versus open pyloromyotomy for
the management of hypertrophic pyloric stenosis.
 SUMMARY

 As noted ealier, the focus of nursing practice change should be on the

optimization of post-operative feeding regime.
 Generally, patients who have undergone surgical treatment of pyloric stenosis
(pyloromyotomy) experience and excellent recovery process with minimal long-
term effects. Post-operative feeding regimen for infants usually involves feeding
of special fluids for or two feedings followed by breast milk/formula within a
period of 24 hours.
 Recent evidence suggest that progress has been achieved in the care of infants
with hypertrophic pyloric stenosis. Such progress includes the use of earlier
operative interventions and shorter hospital length of stay (LOS)-all of these
attributed to expedited feeding protocols developed by surgeons but
implemented by nurses. Studies have shown that HPS patients admitted to
units that are co-managed by nonsurgeons (nurses) providers postoperatively
have longer LOS that in standard surgical wards. The implication is that nurses
in pyloromyotomy should be supervised by surgeons for improved standard of
care to be achieved.
 References

 2021. [image] Available at: <https://www.medindia.net/patients/patientinfo/treatment-of-pyloric-stenosis-in-adults.htm> [Accessed 4

September 2021].
 Acker, S. N., Kulungowski, A. M., Hodges, M., Crombleholme, T. M., Somme, S., & Partrick, D. A. (2015). Pyloric stenosis—postoperative
care on a nonsurgical ward. journal of surgical research, 199(1), 149-152.
 Binet, A., Klipfel, C., Meignan, P., Bastard, F., Cook, A. R., Braïk, K., ... & Lardy, H. (2018). Laparoscopic pyloromyotomy for hypertrophic
pyloric stenosis: a survey of 407 children. Pediatric surgery international, 34(4), 421-426.
 Binet, A., Klipfel, C., Meignan, P., Bastard, F., Cook, A. R., Braïk, K., ... & Lardy, H. (2018). Laparoscopic pyloromyotomy for hypertrophic
pyloric stenosis: a survey of 407 children. Pediatric surgery international, 34(4), 421-42 
 Clayton, J. T., Reisch, J. S., Sanchez, P. J., Fickes, J. L., Portillo, C. M., & Chen, L. E. (2015). Postoperative regimentation of treatment
optimizes care and optimizes length of stay (PROTOCOL) after pyloromyotomy. Journal of pediatric surgery, 50(9), 1540-1543.
 Costanzo, C. M., Vinocur, C., & Berman, L. (2018). Postoperative outcomes of open versus laparoscopic pyloromyotomy for hypertrophic
pyloric stenosis. Journal of Surgical Research, 224, 240-244.
 Kethman, W. C., Harris, A. H., Hawn, M. T., & Wall, J. K. (2018). Trends and surgical outcomes of laparoscopic versus open
pyloromyotomy. Surgical endoscopy, 32(7), 3380-3385.
 Ismail, I., Elsherbini, R., Elsaied, A., Aly, K., & Sheir, H. (2020). Laparoscopic vs. Open Pyloromyotomy in Treatment of Infantile
Hypertrophic Pyloric Stenosis. Frontiers in Pediatrics, 8, 426
 Oldland, E., Botti, M., Hutchinson, A. M., & Redley, B. (2020). A framework of nurses’ responsibilities for quality healthcare—Exploration
of content validity. Collegian, 27(2), 150-163 
 Sathya, C., Wayne, C., Gotsch, A., Vincent, J., Sullivan, K. J., & Nasr, A. (2017). Laparoscopic versus open pyloromyotomy in infants: a
systematic review and meta-analysis. Pediatric surgery international, 33(3), 325-333 
 Staerkle, R. F., Lunger, F., Fink, L., Sasse, T., Lacher, M., Elm, E., ... & Vuille-dit-Bille, R. N. (2021). Open versus laparoscopic
pyloromyotomy for pyloric stenosis. Cochrane Database of Systematic Reviews, (3)
 Wenk, K., Humoud, I., Fink, L., Sasse, T., Staerkle, R. F., Lacher, M., ... & Vuille‐dit‐Bille, R. N. (2017). Open versus laparoscopic
pyloromyotomy for pyloric stenosis. The Cochrane Database of Systematic Reviews, 2017(10)