What is the role of surgery in the treatment of pediatric pyloric stenosis?

Updated: Nov 13, 2018
  • Author: Sathyaseelan Subramaniam, MD, FAAP; Chief Editor: Kirsten A Bechtel, MD  more...
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  • The definitive treatment for infantile hypertrophic pyloric stenosis is corrective surgery.
  • The Ramstedt pyloromyotomy is the current procedure of choice, during which the underlying antro-pyloric mass is split leaving the mucosal layer intact.
    • Traditionally, the pyloromyotomy was performed through a right upper quadrant transverse incision. New studies have compared the operative time, cost, and hospital stay associated with the traditional incision, a circumbilical incision (believed to have improved cosmesis), and a laparoscopic procedure.
    • Studies have shown laparoscopic pyloromyotomy to have fewer complications, reduced time to full feeds and hospital length of stay compared to open pyloromyotomy. [18, 19] However, a meta-analysis of 4 randomized controlled trials comparing laparoscopic pyloromyotomy to open pyloromyotomy found no difference in complication rates, or hospital length of stay between the two groups. It did find a reduction in time to full feeds by 2 hours in the laparoscopic pyloromyotomy group. [20]

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