How is pyloric stenosis treated?

If pyloric stenosis is seen and diagnosed from the physical exam, ultrasound or gastrointestinal studies, surgery must be done to correct the condition. Because infants with HPS are often dehydrated from extended vomiting, proper replacement of fluids is necessary before surgery can be performed. Blood tests can help detect dehydration. Sometimes, delivering fluids intravenously (through a vein in the arm) is necessary.

Before the surgery

Your child will not be allowed to have any milk or formula for 6 hours before surgery to reduce the risk of vomiting and aspiration while under anesthesia.

During the surgery

The following events will take place in the event of a surgery:

  • A pediatric anesthesiologist (a physician who specializes in sedation and pain relief in children) gives your child general anesthesia, which induces sleep.
  • A small incision is made on the left side of the abdomen, higher than the umbilicus (belly button).
  • The surgeon then performs a "pyloromyotomy," which involves making an incision in the thickened pylorus to allow food to move out of the stomach into the intestines properly. This procedure generally takes less than an hour to complete.

After the surgery

The usual length of stay after surgery is 24 to 36 hours. Several hours after surgery, your child will be able to eat again. Oral (by mouth) feedings are started very slowly, in very small amounts. The volume and concentration of the formula will be increased as your child is able to tolerate the feeding. If you breastfeed your child, breast milk must be given to your child through a bottle for the first few feedings so that it can be accurately measured.

Sometimes, babies will still vomit after surgery, but this does not mean that they have pyloric stenosis again. Your child might vomit after surgery because of the anesthesia. Your child also might vomit if feedings advance too quickly or if your child is not adequately burped after feedings. If your child continues to vomit for a prolonged periods, he or she may need more tests. Problems with vomiting should be corrected before your child is discharged from the hospital.

How do I care for my child after surgery?

Your child will be eating normally by the time you go home. Usually, non-narcotic pain medication (such as Tylenol®) is all that is needed to control minimal post-operative pain. You may give your child a sponge bath the day after surgery. You may bathe your child in the tub 3 days after surgery.

The small piece of tape covering the incision (called a Steri-Strip™) will gradually fall off on its own. Do not pull this tape off yourself. If the Steri-Strip has not fallen off by the time of your follow-up appointment, your healthcare provider will remove it for you.

Follow-up appointment

A follow-up outpatient visit will be scheduled 7 to 10 days after your child's surgery. Your child's healthcare provider will examine the wound site and evaluate your child's recovery.

Last reviewed by a Cleveland Clinic medical professional on 12/22/2016.

References

  • Aspelund G, Langer JC. Current management of hypertrophic pyloric stenosis. Sem Ped Surg 2007;16:27-33.
  • Merck Manual. Hypertrophic Pyloric stenosis. Accessed 1/31/2017.

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