Treatment for Pyloric Stenosis
The first step in treating pyloric stenosis is to replenish fluids and electrolytes through intravenous rehydration. The second step in treatment is surgery. Surgery to correct pyloric stenosis is called pyloromyotomy.
Pyloromyotomy, which is performed under general anesthesia, usually takes about 1 hour. To reduce the risk for vomiting during the procedure, infants are not fed prior to surgery. Several incision sites are possible: the right upper abdomen, the navel area, or a combination of three small incisions (if the procedure is being done laparoscopically).
In this procedure, the surgeon cuts the thickened pyloric muscle and spreads it apart, opening the passage so that food can properly travel from the stomach to the small intestine. No tissue is removed, the pylorus heals on its own, and the thickening eventually dissolves, leaving a normal pyloric area. In most cases, infants can be fed a few hours after the surgery.
Following pyloromyotomy, babies usually are released from the hospital after a day or two. Pain relievers (e.g., Tylenol) may be given for discomfort. After surgery, infants may vomit occasionally. If vomiting occurs 3 or more times a day or several days in a row, parents should contact their child's physician.
Most children recover from the surgery without complications, but there are some risks associated with pyloromyotomy. These risks include bleeding, infection, and hernia.
In some cases, the cut in the pyloric muscle is not sufficient to relieve symptoms. Rarely, a leak develops in the intestine, requiring additional surgery. Severe complications resulting in death (occurs in fewer than 4 children out of 100) usually are associated with other health problems.
In babies who cannot have surgery due to other medical conditions, a balloon dilation procedure may be performed to correct pyloric stenosis. In this procedure, a tube with a balloon at the end is inserted down the baby's esophagus to the stomach. The balloon is then inflated, separating the affected tissue. However, this is not as effective as pyloromyotomy, which has become the standard treatment operation.
Researchers are studying the effectiveness of other non-surgical treatments for babies who cannot have surgery or whose parents object to it. Atropine sulfate, given either orally or intravenously, has been successful, but more study is needed.