Pyloric stenosis is a condition in infants where the pylorus, the muscular valve between the stomach and small intestine, thickens. This enlargement narrows the passage and prevents food from properly moving out of the stomach. The condition typically appears in babies between two and eight weeks of age, and its most distinct symptom is forceful, projectile vomiting that occurs soon after a feeding.
As the blockage worsens, infants often display constant hunger and may have visible, wave-like stomach contractions. This persistent vomiting can lead to dehydration, weight loss, and an imbalance of electrolytes. The standard treatment is a laparoscopic pyloromyotomy, a surgical procedure designed to relieve the obstruction.
The Laparoscopic Pyloromyotomy Procedure
Before surgery, the infant’s health must be stabilized. The most immediate concern is correcting dehydration and electrolyte imbalances with intravenous (IV) fluids over 24 to 48 hours. Medical staff will monitor the infant’s condition with blood tests to ensure their body chemistry returns to a normal state before the operation.
The surgery is performed under general anesthesia. The laparoscopic approach is minimally invasive, beginning with a few small incisions, typically around the navel. One incision is used to insert a laparoscope, a thin tube with a camera that transmits a view of the abdominal organs to a monitor. The other small incisions allow for the introduction of tiny surgical instruments.
Using these instruments, the surgeon performs the myotomy. This involves making a precise, lengthwise cut through the outer, thickened layers of the pyloric muscle, while carefully avoiding the inner lining of the stomach. Once the muscle is cut, it is spread apart, which allows the inner lining to bulge outward, opening the narrowed channel and relieving the food blockage.
Immediate Post-Operative Hospital Care
Following the procedure, the infant is moved to a recovery room for observation. The main goal during this post-operative period is the gradual reintroduction of feeding. Feedings typically begin a few hours after surgery, once the infant is awake and stable.
The process starts with small amounts of a clear liquid or an electrolyte solution like Pedialyte. If the infant tolerates these initial feeds well, they will progress to breast milk or formula. The volume of each feeding is increased slowly to an age-appropriate amount. It is common for infants to experience some spitting up or vomiting after the first few feedings as their digestive system adjusts.
Pain management is also a focus of post-operative care. Infants are given pain relievers, such as acetaminophen, to ensure they remain comfortable. Nursing staff will continue to monitor the baby’s vital signs and check the small incision sites. The IV line often remains in place until the infant is feeding well and fully hydrated, at which point it is removed. Most babies are ready for discharge from the hospital within one to two days.
At-Home Recovery and Feeding
At-home care focuses on incision care and monitoring feeding. The small surgical incisions are typically closed with surgical glue or small adhesive strips called Steri-Strips. These strips will fall off on their own in about a week, and parents are instructed to keep the area clean and dry, avoiding tub baths for a week.
Parents should monitor the incision sites for any signs of infection. These symptoms are uncommon but require prompt medical attention if they appear. Reasons to contact the pediatrician include:
- Increasing redness, swelling, bleeding, or any discharge from the incisions
- A fever greater than 101°F (38.6°C)
- Pain that worsens and is not relieved by acetaminophen
Regarding feeding, most infants can return to their normal feeding schedules shortly after returning home. While minor spitting up can be normal, the return of forceful or projectile vomiting is not expected and warrants a call to the doctor. Likewise, any signs of dehydration, such as fewer wet diapers, crying without tears, or unusual lethargy, should be reported to the pediatrician immediately.
Surgical Risks and Comparison to Open Pyloromyotomy
Laparoscopic pyloromyotomy is a safe procedure, but like any surgery, it carries some risks. These include general risks associated with anesthesia, as well as bleeding or infection at the incision sites. Specific to this procedure, there is a small risk of an incomplete myotomy, where the muscle is not cut sufficiently, or a perforation, which is an accidental tear in the inner stomach lining. These complications are infrequent.
This minimally invasive technique is often preferred over the traditional open pyloromyotomy, where a single, larger incision is made in the abdomen to access the pylorus. The primary advantages of the laparoscopic method are related to the smaller incisions.
Patients who undergo the laparoscopic procedure generally experience a faster recovery time and have less noticeable scarring. Studies have shown the laparoscopic approach is associated with a shorter surgery, a quicker return to feeding, and often a shorter hospital stay compared to the open technique.