Pyloromyotomy for Pyloric Stenosis

Definition

The incision and suturing of the muscles of the pylorus to treat congenital hypertrophy of the pyloric sphincter (pyloric stenosis) that can cause pyloric and/ or gastric obstruction.

Pyloromyotomy for Pyloric Stenosis

Discussion
  • The Ramsted-Fredet pyloromyotomy is the procedure of choice to correct this defect surgically.
  • Signs and symptoms of high gastrointestinal obstruction usually appear at around 2 to 6 weeks of age, with first symptom being projectile vomiting that is free of bile.
  • As a precautionary measure, the stomach is emptied via a nasogastric tube prior to induction of anesthesia, and the nasogastric tube is then removed to prevent gastric contents from accumulating around the tube during the procedure.
Positioning
  • Supine, with arms restrained at the side.
Packs/ Drapes
  • Pediatric transverse Lap sheet or basic pack and sheet with small fenestration.
Instrumentation
  • Pediatric laparotomy tray
  • Pyloric spreaders
Supplies/ Equipment
  • Thermal blanket with control unit
  • Thermal sheets, head covering
  • Basin set
  • Handheld cautery
  • Blades
  • Needle counter
  • Dissector sponges
  • Solutions
  • Sutures
Procedure Overview
  1. The abdomen is opened through a right subcostal transverse incision, splitting the rectus muscle vertically and excising the peritoneum.
  2. The pylorus is delivered into the wound and rotated to expose the anterior superior border of the mass.
  3. Using a pyloric spreader, all remaining circular muscle fibers are separated to the level of the submucosa.
  4. Any lacerations of the gastric or duodenal mucosa are immediately repaired.
  5. After hemostasis is achieved, the peritoneum and posterior rectus sheath are closed with a continuous absorbable suture.
  6. The anterior rectus sheath is closed with absorbable suture and the skin is closed using a subcuticular technique.
  7. Steri-strips are applied with an abdominal dressing.
Perioperative Nursing Considerations
  1. Maintain aseptic technique during the procedure.
  2. If tape is being used during positioning, do not allow tape directly contact the skin.
  3. Do not begin skin preparation without specific instruction from the surgeon.
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