They will also need a nasogastric tube, which is passed up the nose, down the food-pipe and into the stomach. This will drain off the stomach contents before the operation.
If the child has any medical problems, such as allergies, parents should tell the doctors. While the child is under general anaesthetic, the surgeon will cut through some of the thickened muscle, which widens the passage so that milk and food can pass into the bowel to be digested. If the operation was carried out using keyhole surgery, the child will have three small incisions in the abdomen, which will be closed with dissolvable stitches and skin glue. All surgery carries a small risk of bleeding during or after the operation.
There is a chance that the lining of the bowel could be damaged during the operation, but this is rare and will be stitched closed during the same operation. Every anaesthetic carries a risk of complications but this is very small. The child will come back to the ward to recover. He or she will have been given pain relief during and after the operation. For the first few hours, the child will continue to have fluids through the drip so that the stomach and bowel can start to heal.
After six hours or so, we will start to feed the child, starting with small amounts, and increasing the amount as he or she tolerates it. Your child may still have some vomiting but this will improve as the digestive system recovers from the operation.
Your child will be able to go home once he or she is feeding well. The child will need to have regular pain relief such as paracetamol for at least three days so please make sure that you have some at home. The stitches used during the operation will dissolve on their own so there is no need to have them removed. Pyloric stenosis affects about 3 out of 1, babies in the United States. Most infants who have it develop symptoms 3 to 5 weeks after birth.
It's thought that babies who develop pyloric stenosis are not born with it, but have progressive thickening of the pylorus after birth. A baby will start to show symptoms when the pylorus is so thick that the stomach can't empty properly. The cause of this thickening isn't clear.
It might be a combination of several things. For example, use of erythromycin an antibiotic in babies in the first 2 weeks of life or antibiotics given to moms at the end of pregnancy or during breastfeeding can be associated with pyloric stenosis. The doctor will ask detailed questions about the baby's feeding and vomiting patterns, including what the vomit looks like.
The doctor will do an exam, and note any weight loss or failure to maintain growth since birth. The doctor will check for a lump in the abdomen. If the doctor feels this lump, which usually is firm and movable and feels like an olive, it's a strong indication that a baby has pyloric stenosis. If pyloric stenosis seems likely, the doctor probably will order an abdominal ultrasound.
The enlarged, thickened pylorus will show on ultrasound images. The doctor may ask that the baby not be fed for several hours before an ultrasound. Sometimes doctors order a barium swallow instead of an ultrasound. Babies swallow a small amount of a chalky liquid barium. Then, special X-rays are done that let the doctor check the pyloric area for any narrowing or blockage. The doctor also might order blood tests to check levels of electrolytes minerals that help keep fluids balanced and vital organs working properly.
An electrolyte imbalance often happens due to the ongoing vomiting of stomach acid and dehydration, and needs to be corrected. When an infant is diagnosed with pyloric stenosis, either by ultrasound or barium swallow, the baby will be admitted to the hospital and prepared for surgery. Any dehydration or electrolyte problems in the blood will be corrected with intravenous IV fluids, usually within 24 hours. Doctors do a surgery called pyloromyotomy pie-lor-oh-my-OT-uh-me to relieve the blockage.
Using a small incision cut , the surgeon examines the pylorus and separates and spreads the thick, tight muscles. This relaxes and opens those muscles. The surgery can also be done through laparoscopy. This technique uses a tiny scope placed through a small cut in the belly button, letting the doctor see the area of the pylorus.
Using other small instruments placed in nearby incisions, the doctor can complete the surgery. In this procedure, surgeons divide the muscle of the pylorus to open up the gastric outlet. By doing laparoscopic surgery, we can minimize scarring, decrease potential infections and improve recovery time for children. Your baby will receive general anesthesia to put her to sleep during the procedure. Once she's asleep, the surgeon will make small laparoscopic incisions in the belly.
The surgeon cuts the muscle layer, then puts a numbing medicine into the area and closes the incision. These stitches will be under the skin and won't need to be removed. After your baby wakes up, she'll go to the recovery room for several hours, then to her own hospital room.
Here's what to expect:. Your baby will be discharged one or two days after surgery if she doesn't have a fever, is eating and not vomiting, and her incision isn't red or draining. If your child is still having problems with frequent spitting up after surgery, she may be diagnosed with gastroesophageal reflux GER. You should follow up with your primary care physician to be evaluated for gastroesophageal reflux. Pyloric stenosis is unlikely to reoccur.
Babies who have undergone surgery for pyloric stenosis should have no long-term effects from it. Pyloric Stenosis. Appointments and Referrals. In addition to a complete history and physical exam, certain diagnostic procedures are used to confirm the diagnosis of pyloric stenosis: Ultrasound : the most common imaging test used to see the thickened pylorus. Upper GI series : a series of X-rays taken after your baby drinks a special contrast agent.
The contrast agent illuminates the narrowed pyloric outlet and shows how the stomach empties. Pyloric stenosis surgery Surgery to correct pyloric stenosis is called a pyloromyotomy. The steri-strips will fall off on their own.
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