Child Health/Paediatric surgery

Ramstedt pyloromyotomy

also: pyloric stenosis surgery · pyloromyotomy

Overview

Surgical division of the hypertrophied pylorus — the treatment of pyloric stenosis. The key teaching is to correct the metabolic disturbance FIRST.

Mechanism

Longitudinal division of the hypertrophied pyloric muscle (mucosa left intact) relieves the gastric outlet obstruction. It is NOT an emergency operation — the hypochloraemic hypokalaemic alkalosis must be corrected with IV fluids first (anaesthetic safety).

Indications

Infantile hypertrophic pyloric stenosis

The agents

Laparoscopic / open pyloromyotomyafter fluid resuscitation

Feed within hours; excellent prognosis.

Adverse effects

Mucosal perforationserious

Incomplete myotomy (persistent vomiting)common

Wound infectioncommon

Cautions & contraindications

Operating before correcting the alkalosis/electrolytespaediatric

Alkalosis → apnoea risk under anaesthesia; resuscitate first.

Choosing it

Firstborn boy ~6 weeks old, projectile NON-bilious vomiting after feeds, still hungry, palpable "olive" in the RUQ, with hypochloraemic hypokalaemic metabolic alkalosis.

Source: BNF for Children — — · OHCS — Pyloric stenosis