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What to Know About Pyloromyotomy in Children

Medically Reviewed by Dan Brennan, MD on August 06, 2022

If your baby is experiencing strange symptoms including vomiting, dehydration, and crying, you might immediately suspect a viral or bacterial illness. Your baby’s pediatrician might notice a small, hard lump in your baby’s belly when performing a physical examination and bring up pyloric stenosis instead. 

Fortunately, pyloric stenosis is rare and can be cured with surgery. Learn how to recognize symptoms of pyloric stenosis and gain an understanding of pyloromyotomy in children, mainly babies.

What Is Pyloric Stenosis?

Pyloric stenosis is when the pylorus muscle thickens and becomes enlarged, and it’s seen only in babies.

The pylorus is a thick, muscular band that connects the end of the stomach to the mouth of the small intestine. In a digestive system that’s working normally, once ready for the next stage of digestion, the contents of the stomach move through the pylorus into the small intestine. 

In a baby with pyloric stenosis, the pylorus muscle thickens to a point where it starts preventing food from  entering the small intestine. When this happens, the baby is unable to digest and take nourishment from food. This leads to discomfort, vomiting, and eventually, dehydration and malnourishment. 

Pyloric stenosis is rare — in the U.S., it’s seen in only three out of 1000 newborns. Also, it’s a curable condition that can be easily diagnosed and fixed with minimally invasive surgery. 

What Are the Symptoms of Pyloric Stenosis?

Stomach symptoms like vomiting and nausea are common in children, and often are not serious or life-threatening. The symptoms of pyloric stenosis, on the other hand, are more severe and include:

  • Progressively worsening projectile vomiting after drinking breastmilk or formula. This is a hallmark symptom of pyloric stenosis. Most babies spit up occasionally, but for most babies, spit-up is not a health concern and it does not get progressively worse over time. Talk to your doctor if you’re unsure if you should be concerned.
  • Stomach contractions after feeding but before vomiting. These contractions move across your baby’s belly.
  • Dehydration despite feeding on a regular schedule. The signs of extreme dehydration may include your baby acting very sleepy and no longer wetting their diaper or producing tears. 
  • Hunger that doesn’t seem to go away, or crying after feeding.
  • Difficulty gaining weight or losing weight. This may be due to a lack of nutrition. 

Pyloric stenosis usually appears in babies younger than 3 months. If an older child has these stomach symptoms, it’s probably not pyloric stenosis, but if your weeks-old baby has extreme vomiting or dehydration, talk to your pediatrician about potential pylorus function problems as soon as possible. 

What Is a Pyloromyotomy?

A pyloromyotomy is a relatively simple procedure that fixes the thickened pylorus.

During the procedure, your pediatric surgeon will make a small cut on your baby’s belly to insert a laparoscope — a thin tube with a small camera at its ends — to guide the surgery. Then, they’ll make two more tiny cuts around the first to insert surgical instruments for getting to the pylorus.

Once inside, the surgeon will use these instruments to cut the outer enlarged part of the pylorus so that partially digested food from the stomach can flow into the small intestine.

What Are the Benefits and Risks of Pyloromyotomy in Children?

Pyloromyotomy is the only effective treatment available for pyloric stenosis. Here are some benefits and risks of this procedure:

Benefits. In most cases, your baby will probably be able to leave the hospital in a few days with the assurance that they’ll be able to eat normally without vomiting.

Risks. Pyloromyotomy has relatively few risks. Specifically, there are two possible risks, which occur in less than 1% of cases — a tear in the thin, inner layer of the pyloric muscle and an outcome where the child continues to vomit after surgery. If your baby is operated on by an experienced team of pediatric surgeons, your baby’s overall risk for complications will be low. 

A pyloromyotomy is your baby’s best chance at living a healthy life. Before surgery, talk to your doctor about any kind of medications or supplements you give your baby and about other medical conditions your baby has been diagnosed with before the surgery.

How Do You Care for a Child Who Is Recovering From a Pyloromyotomy?

Since babies are under general anesthesia during the surgery, they aren’t aware of the procedure and don’t feel anxious or in pain. After the surgery, your baby will probably need to stay in the hospital recovery room for a few hours before being moved to an individual room.

Here’s a list of a few things you should be aware of when your baby is recovering from a pyloromyotomy.

Bandages and Stitches. Small, sterile strips are used to close up the surface cuts the surgeon makes during pyloromyotomy surgery. Your baby probably won’t have true stitches on the top layers of their skin, but there’ll be stitches underneath the skin. 

You won’t need to do anything about your baby’s stitches besides checking them for signs of infection. Watch for redness or oozing pus in the incision location, and check your baby’s temperature for a fever.

Pain Control. Pyloromyotomy is minimally invasive, which means it’s performed using tiny cuts, so your child will probably not feel any extreme pain after the procedure.

Focus on feeding your child appropriate amounts of either breastmilk or formula, and give acetaminophen or ibuprofen as directed by your pediatrician if your child is in pain. If you see any signs of infection, call your doctor immediately.

Diet. Your baby is probably hungry, so you might want to start feeding in the recovery room. Most often, your child will begin feeding normally within 24 hours after the procedure.

Follow your doctor’s pyloromyotomy post-op care instructions for feeding after the procedure as some babies can’t drink large amounts of breastmilk or formula right away. Small amounts of spit-up are normal.

A pyloromyotomy is a good option for a baby who is showing vomiting, malnutrition, or dehydration symptoms and so may have pyloric stenosis. After a successful pyloromyotomy, your baby will lead a normal life while feeding correctly without complications from pyloric stenosis.

If your baby seems to be in extreme pain after the surgery (which can’t be relieved by the prescribed medication), develops a fever, or has any symptoms that worry you, reach out to your doctor as soon as possible. 

Show Sources

SOURCES:

Children’s Hospital of Philadelphia: “Pyloric Stenosis.”

Harvard Health Publishing: “10 signs that a child’s stomachache could be something serious.”

Mass General for Children: “How to Care for Your Child at Home After a Pyloromyotomy.”

Mayo Clinic: “Pyloric stenosis.”

National Cancer Institute: “pylorus.”

WakeMed: “Pyloric Stenosis,” “Pyloromyotomy: What to Expect.”

Yale Medicine: “Pyloric Stenosis.”

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