From the Research
The treatment for pyloric stenosis is surgical correction through a procedure called pyloromyotomy, which is the definitive treatment and involves making an incision in the thickened pyloric muscle to relieve the obstruction between the stomach and small intestine. This procedure has been shown to be highly effective, with a study published in 2018 1 demonstrating a sensitivity of 96% for ultrasound examination in diagnosing pyloric stenosis and a cure rate of 100% for pyloromyotomy.
Before surgery, patients (typically infants) need to be stabilized with IV fluids to correct dehydration and electrolyte imbalances, particularly hypochloremic metabolic alkalosis, which commonly occurs due to prolonged vomiting. Nasogastric tube placement may be necessary to decompress the stomach. The surgery is typically performed laparoscopically, which allows for smaller incisions and faster recovery, as demonstrated by a study published in 2009 2 that compared open and laparoscopic pyloromyotomy and found that the laparoscopic approach resulted in shorter time to achieve full enteral feeding and shorter postoperative length of stay.
After surgery, feeding is gradually reintroduced, usually starting with small amounts of clear liquids and advancing to formula or breast milk as tolerated. Most infants can resume normal feeding within 24-48 hours post-surgery. The success rate for pyloromyotomy is excellent, with over 95% of patients experiencing complete resolution of symptoms and very low recurrence rates. Surgery is necessary because pyloric stenosis involves physical thickening of the pyloric muscle (pyloric hypertrophy), which creates a mechanical obstruction that cannot be effectively treated with medications alone.
Some key considerations in the management of pyloric stenosis include:
- Preoperative stabilization with IV fluids to correct dehydration and electrolyte imbalances
- Use of ultrasound examination for diagnosis, which has a high sensitivity and specificity
- Laparoscopic pyloromyotomy as the preferred surgical approach due to its advantages in terms of faster recovery and shorter hospital stay
- Gradual reintroduction of feeding post-surgery, starting with clear liquids and advancing to formula or breast milk as tolerated.
It's also important to note that the degree of hypochloremic, hypokalemic, metabolic alkalosis on presentation can correlate with the number of episodes of postoperative emesis and time to goal feeds, as demonstrated by a study published in 2008 3. Additionally, a study published in 2016 4 found that presenting chloride levels can be used to predict the need for multiple saline boluses and that a patient with an initial chloride level ≤97 mmol/L will need two 20ml/kg boluses 73% of the time.
Overall, pyloromyotomy is a highly effective treatment for pyloric stenosis, and with proper preoperative stabilization, surgical technique, and postoperative care, most infants can achieve complete resolution of symptoms and return to normal feeding within a short period of time.