Pyloromyotomy for Pyloric Stenosis
October 16, 2010 · 1 Comment
Definition
The incision and suturing of the muscles of the pylorus to treat congenital hypertrophy of the pyloric sphincter (pyloric stenosis) that can cause pyloric and/ or gastric obstruction.
Discussion
- The Ramsted-Fredet pyloromyotomy is the procedure of choice to correct this defect surgically.
- Signs and symptoms of high gastrointestinal obstruction usually appear at around 2 to 6 weeks of age, with first symptom being projectile vomiting that is free of bile.
- As a precautionary measure, the stomach is emptied via a nasogastric tube prior to induction of anesthesia, and the nasogastric tube is then removed to prevent gastric contents from accumulating around the tube during the procedure.
Positioning
- Supine, with arms restrained at the side.
Packs/ Drapes
- Pediatric transverse Lap sheet or basic pack and sheet with small fenestration.
Instrumentation
- Pediatric laparotomy tray
- Pyloric spreaders
Supplies/ Equipment
- Thermal blanket with control unit
- Thermal sheets, head covering
- Basin set
- Handheld cautery
- Blades
- Needle counter
- Dissector sponges
- Solutions
- Sutures
Procedure Overview
- The abdomen is opened through a right subcostal transverse incision, splitting the rectus muscle vertically and excising the peritoneum.
- The pylorus is delivered into the wound and rotated to expose the anterior superior border of the mass.
- Using a pyloric spreader, all remaining circular muscle fibers are separated to the level of the submucosa.
- Any lacerations of the gastric or duodenal mucosa are immediately repaired.
- After hemostasis is achieved, the peritoneum and posterior rectus sheath are closed with a continuous absorbable suture.
- The anterior rectus sheath is closed with absorbable suture and the skin is closed using a subcuticular technique.
- Steri-strips are applied with an abdominal dressing.
Perioperative Nursing Considerations
- Maintain aseptic technique during the procedure.
- If tape is being used during positioning, do not allow tape directly contact the skin.
- Do not begin skin preparation without specific instruction from the surgeon.
Currently a Nursing Local Board Examination Reviewer. Subjects handled are Pediatric, Obstetric and Psychiatric Nursing.
Previous work experiences include: Clinical instructor/lecturer, clinical coordinator (Level II), caregiver instructor/lecturer, NC2 examination reviewer and staff/clinic nurse.
Areas of specialization: Emergency room, Orthopedic Ward and Delivery Room. Also an IELTS passer.
nung araw na nagpost ka about pyloric stenosis oct. 16, 2010 tapos 3days after nakitaan ko sya ng sobrang pag lungad na lumalabas pa sa ilong. nangyayari un after pinadede ko sya, binabreastfeed ko sya. nov. 24, pinacheck up ko na sya sa pedia sa umc, pina advise na ipa xray sya kc symptoms ng pyloric stenosis, kso d sila mkakuha ng nice shot sa xray kaya up to now dpa confirm ung findings. hangang ngaun ganun pa din ung baby ko. ask ko lang sana kung meron pang ibang paraan bukod sa operation, kung sakaling maooperahan magkano ang estimated budget baka my idea ka. kaya nba ng baby ko ang procedure ng operation? pls reply asap kc nag woworry ako para sa baby ko.