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A small cut is made in the thickened muscle of the pylorus and it is spread apart
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What is cured by pyloromyotomy?
Pyloric stenosis can be cured with a surgical procedure called a pyloromyotomy
What are the symptom's of pyloromyotomy?
Some symptoms of pyloromyotomy is pain in your abdomen, burping, and being constantly hungry. Other symptoms are dehydration and?æthe failure to loose or gain weight.
Does a pyloromyotomy use a laparoscope?
The procedure may be performed with the aid of a laparoscope
How long does a pyloromyotomy take?
The whole procedure (including anesthesia) takes about an hour
When can infants go home after a pyloromyotomy?
Most babies go home one or two days after surgery
Can Pyloric stenosis reoccur in infants?
In brief, it can but it is rare if the surgeon concerned is skilled and careful. The enlargement (hypertrophy) of the pyloric ring muscle in babies does sometimes reoccur after the operation, but there don't seem to have been any studies to find out how often this happens over a significant number of cases. Typically, there are a few recurrences and one death reported in surveys of say about 100 operations in one centre, but other reports admit to very few complications and less than 1:100 deaths. The surgery (pyloromyotomy) stops the blockage of the stomach outlet by slitting the muscle ring down to but not including the inner lining (omentum) of the gastric passage. Too long or deep a slit opens the gastric passage and must be immediately recognised and repaired to prevent a catastrophic infection setting in. But if the slit in the muscle band is not long enough or if the cut edges are not spread widely enough to let the omentum bulge into the cut, the cut muscle will close, reconnect and can then continue to enlarge as a result of the biochemical process that caused the original swelling. So IPS can reoccur - but how often depends on the skill and thoroughness of the surgeon concerned, and will vary from one to another.
Pyloric stenosis?
DefinitionPyloric stenosis is a narrowing of the pylorus, the opening from the stomach into the small intestine.Alternative NamesCongenital hypertrophic pyloric stenosis; Hypertrophic pyloric stenosis; Gastric outlet obstructionCauses, incidence, and risk factorsNormally, food passes easily from the stomach into the duodenum (the first part of the small intestine) through a valve called the pylorus. In pyloric stenosis, the muscles of the pylorus are thickened. This thickening prevents the stomach from emptying into the small intestine.The cause of the thickening is unknown, although genetic factors may play a role. Children of parents who had pyloric stenosis are more likely to have this problem.Pyloric stenosis occurs more often in boys than in girls, and is rare in children older than 6 months. The condition is usually diagnosed by the time a child is 6 months old.SymptomsVomiting is the first symptom in most children:Vomiting may occur after every feeding or only after some feedingsVomiting usually starts around 3 weeks of age, but may start any time between 1 week and 5 months of ageVomiting is forceful (projectile vomiting)The infant is hungry after vomiting and wants to feed againOther symptoms generally appear several weeks after birth and may include:Abdominal painBelchingConstant hungerDehydration (gets worse with the severity of the vomiting)Failure to gain weight or weight lossWave-like motion of the abdomen shortly after feeding and just before vomiting occursSigns and testsThe condition is usually diagnosed before the baby is 6 months old.A physical exam may reveal signs of dehydration. The infant may have a swollen belly. The doctor may detect the abnormal pylorus, which feels like an olive-shaped mass, when touching the stomach area.An ultrasound of the abdomen may be the first imaging test performed. Other tests that may be done include:Barium x-ray -- reveals a swollen stomach and narrowed pylorusBlood chemistry panel -- often reveals an electrolyte imbalanceTreatmentTreatment for pyloric stenosis involves surgery (called a pyloromyotomy) to split the overdeveloped muscles.Balloon dilation does not work as well as surgery, but may be considered for infants when the risk of general anesthesia is high.The patient will be given fluids through a vein, usually before surgery.Expectations (prognosis)Surgery usually provides complete relief of symptoms. The infant can usually tolerate small, frequent feedings several hours after surgery.ComplicationsVomiting after surgery -- this is very common and generally improves with timeFailure to gain weight in the newborn periodRisks associated with any surgery, which include: BleedingInfectionCalling your health care providerCall your health care provider if your baby has symptoms of this condition.ReferencesWyllie R. Pyloric stenosis and congenital anomalies of the stomach. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds.Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 326.
What is pyloric?
Pyloric Stenosis (PS) is the thickening of the pylorus (the muscle band at the outlet of the stomach) which results in its narrowing: the canal between the stomach and small intestine becomes unable to pass food. Vomiting, dehydration, wasting and death are the result.This condition can occur in adults when it is usually caused by scarring from ulcers. Such cases are decreasing in numbers due to the identification and treatment of Helicobacter pylori, the ulcer causing bacterium.Today PS occurs most commonly in babies, when the muscle ring mysteriously thickens. In infancy, symptoms usually start between 2 and 8 weeks after birth, although they can appear at any time from birth and during the first six months. Mild cases can remain untreated but cause continuing trouble.The symptoms include chronic and often increasingly violent projectile vomiting after feeds (more than just "sick" or regurgitating milk - it's a real gush or fountain!), poor weight gain or weight loss, and dehydration. Also likely are irregular or loss of bowel movements, stomach cramps, irritability, blood-stained vomit, lethargy and wave movements across the stomach.Incidence The condition is more common in Caucasians and males than females. PS occurs in 2-5 boys in 1000 and about 4 times less often in girls.Treatment The condition can be diagnosed by a Barium swallow, ultrasound, blood tests, and often physically feeling for the "pyloric olive" or swollen muscle through the infant abdominal wall.The medical world is reluctant to suspect PS and rush to surgery when faced with a vomiting baby. Hey, all infants are sick sometimes and how many parents aren't over-anxious? Sadly, careful listening and diagnosis are often a last resort when the baby's condition has deteriorated to an obvious, perhaps critical extent. At that stage surgery after restoring blood chemistry and hydration by IV is often the only option.The surgical treatment is usually by a simple and usually immediately effective procedure to split and spread the pyloric muscle down to the lining of the passage, and recovery takes just a few days in most cases. Open surgery is being increasingly replaced by keyhole access or a small incision around the navel, but these should only be done by a specialist surgeon. The pylorus muscle is like a donut and is split and spread to disable it. This quickly restores normal gastric function and the baby typically thrives! The cut muscle returns to normal over several weeks.Currently the drug Atropine is once again being trialled to treat pyloric stenosis and prevent surgery. It relaxes the pyloric muscle which eventually resumes its normal size and functioning. Many pediatricians and surgeons find the medical treatment option a waste of time as the surgery is quick and effective, whilst Atropine therapy is only successful in about 80-90% of cases, is possible only for non-critical cases and usually takes several weeks of careful treatment in hospital and at home.The causes of infant PS are still little understood but infant PS is multi-factorial. About 20% of patients have one or more relatives with the history. Being a first born male Caucasian with blood group O or B are each risk factors. Maternal stress during the last trimester seems to be one of several circumstantial risk factors and breast feeding seems to be slightly preventative. There are also biochemical indicators which are too technical to detail here.History Apart from hernias and circumcisions pyloromyotomy is the most common surgery among newborn infants. PS has been recognized for about 300 years and a simple surgical remedy that has been available since Conrad Rammstedt's accidental discovery in 1912 started to reduce a horrendous Death Rate to virtually nil.The Future Perhaps because it's so common in pediatric medical practice and so easily and effectively remedied, there seems to be little interest in discovering more about the causes and alternative treatments of PS in infants.However, infant surgery and a scarred body have a long-term effect on some patients and their parents, so early diagnosis and the medical treatment option with Atropine should arguably be considered more often in non-emergency cases.
What is pyloric stenosis?
Pyloric Stenosis (PS) is the thickening of the pylorus (the muscle band at the outlet of the stomach) which results in its narrowing: the canal between the stomach and small intestine becomes unable to pass food. Vomiting, dehydration, wasting and death are the result.This condition can occur in adults when it is usually caused by scarring from ulcers. Such cases are decreasing in numbers due to the identification and treatment of Helicobacter pylori, the ulcer causing bacterium.Today PS occurs most commonly in babies, when the muscle ring mysteriously thickens. In infancy, symptoms usually start between 2 and 8 weeks after birth, although they can appear at any time from birth and during the first six months. Mild cases can remain untreated but cause continuing trouble.The symptoms include chronic and often increasingly violent projectile vomiting after feeds (more than just "sick" or regurgitating milk - it's a real gush or fountain!), poor weight gain or weight loss, and dehydration. Also likely are irregular or loss of bowel movements, stomach cramps, irritability, blood-stained vomit, lethargy and wave movements across the stomach.Incidence The condition is more common in Caucasians and males than females. PS occurs in 2-5 boys in 1000 and about 4 times less often in girls.Treatment The condition can be diagnosed by a Barium swallow, ultrasound, blood tests, and often physically feeling for the "pyloric olive" or swollen muscle through the infant abdominal wall.The medical world is reluctant to suspect PS and rush to surgery when faced with a vomiting baby. Hey, all infants are sick sometimes and how many parents aren't over-anxious? Sadly, careful listening and diagnosis are often a last resort when the baby's condition has deteriorated to an obvious, perhaps critical extent. At that stage surgery after restoring blood chemistry and hydration by IV is often the only option.The surgical treatment is usually by a simple and usually immediately effective procedure to split and spread the pyloric muscle down to the lining of the passage, and recovery takes just a few days in most cases. Open surgery is being increasingly replaced by keyhole access or a small incision around the navel, but these should only be done by a specialist surgeon. The pylorus muscle is like a donut and is split and spread to disable it. This quickly restores normal gastric function and the baby typically thrives! The cut muscle returns to normal over several weeks.Currently the drug Atropine is once again being trialled to treat pyloric stenosis and prevent surgery. It relaxes the pyloric muscle which eventually resumes its normal size and functioning. Many pediatricians and surgeons find the medical treatment option a waste of time as the surgery is quick and effective, whilst Atropine therapy is only successful in about 80-90% of cases, is possible only for non-critical cases and usually takes several weeks of careful treatment in hospital and at home.The causes of infant PS are still little understood but infant PS is multi-factorial. About 20% of patients have one or more relatives with the history. Being a first born male Caucasian with blood group O or B are each risk factors. Maternal stress during the last trimester seems to be one of several circumstantial risk factors and breast feeding seems to be slightly preventative. There are also biochemical indicators which are too technical to detail here.History Apart from hernias and circumcisions pyloromyotomy is the most common surgery among newborn infants. PS has been recognized for about 300 years and a simple surgical remedy that has been available since Conrad Rammstedt's accidental discovery in 1912 started to reduce a horrendous death rate to virtually nil.The Future Perhaps because it's so common in pediatric medical practice and so easily and effectively remedied, there seems to be little interest in discovering more about the causes and alternative treatments of PS in infants.However, infant surgery and a scarred body have a long-term effect on some patients and their parents, so early diagnosis and the medical treatment option with Atropine should arguably be considered more often in non-emergency cases.
