What is pyloric stenosis?
Pyloric stenosis (say: pie-LOR-ick stuh-NO-sis) is a blockage of the pylorus (say: pie-LOR-us). The pylorus is the opening from the stomach to the intestine. There is a muscle around this opening. Normally, this muscle keeps food in the stomach when it tightens and lets food out of the stomach when it relaxes. But when the muscle below the stomach is thick and tight, it cannot relax properly, and a blockage happens. This means the breast milk or formula you feed your baby cannot pass easily from the stomach to the intestine. This makes your baby vomit (throw up).
If your baby's doctor thinks your baby has pyloric stenosis, she will do a physical exam and history and order an ultrasound.
What is a pyloromyotomy?
A pyloromyotomy (say: pie-LOR-oh-my-OTT-uh-mee) is surgery (an operation) to repair the pylorus. During the operation, the surgeon cuts the tight muscle between the stomach and small intestine. This loosens the muscle so the stomach can empty and food will be able to pass easily into the small intestine.
This is a common, simple operation. It normally will not affect your baby's growth.
What to bring to the hospital
Your baby will already be staying in the hospital, so you do not need to bring anything on the day of the operation. But you may want to bring a toy that is special to your baby. On the day they are released from the hospital, bring your baby's car seat for travel home.
Before the operation
Before the operation, you can go with your baby from the inpatient unit to the operating room waiting area. You will then go to the parents' surgical waiting area until the operation is finished.
During the pyloromyotomy
Before the operation starts, your baby will have a special "sleep medicine" called a general anesthetic. This helps make sure your baby sleeps through the operation and does not feel any pain.
The surgeon will make cuts in the pylorus to loosen the muscle.
A pyloromyotomy takes about one hour.
After the pyloromyotomy
After the pyloromyotomy, your baby will go to the Post-Anesthesia Care Unit, also called the PACU or recovery room. They will stay there for about one hour. You can visit your baby when they wake up. Your baby will then go back to the inpatient unit.
Your baby will have an intravenous (IV) tube in their arm. This takes fluids and medicines directly into your baby's blood. The IV will be taken out when it is no longer needed for medicines or fluid and your baby is drinking well.
Your baby can go home when all of the following happen:
- Their heart rate, breathing, blood pressure and temperature are normal.
- They are eating well without vomiting.
- They are comfortable taking pain medicine by mouth.
This is usually one to three days after the operation.
You should plan to take time off work to take care of your baby
It is difficult to plan how much time you will need to take off work. You should be able to go back to work after about one week.
Caring for your baby at home
Care of the incision
The incision (surgical cut) from the operation will be covered by a dressing called steri-strips. You do not need to do anything to the strips. Wash your hands before touching or cleaning the incision area.
A small amount of blood on the strips is common. If the blood seems fresh (bright red in colour) or if the amount of blood increases, press on the area with a clean, dry washcloth for five to six minutes. Then call your baby's surgeon's office. If the bleeding does not stop, take your baby to a family doctor or to the emergency department.
The steri-strips will fall off on their own. If they have not fallen off already, you can take off the strips seven to 10 days after your baby's operation.
Activities
You can allow your baby to do all normal activities once they return home.
Food and drink
During the first 24 hours after the operation, your baby may still vomit. This is common. The vomiting is usually due to the side effects of the pyloric stenosis. It will slowly get better.
Your baby should be able to eat the breast milk or formula they normally eat after the operation.
If your baby has problems eating, call your surgeon's office.
Pain medicine
Your baby can have pain medicine as needed after the first 24 hours. This type of operation is usually not very painful, so your baby should only need plain acetaminophen by mouth.
Bathing
You can give your baby a bath 48 hours after the operation.
When to call the surgery team
The main concerns after a pyloromyotomy are:
- wound infection
- the pyloric stenosis coming back
Call your baby's surgeon's office if you notice any of the following signs or symptoms of infection in your baby:
- fever of 38.5°C (101°F) or higher
- thick yellow or green, foul-smelling discharge from the incision area
- bleeding at the incision area
- redness at the incision area
- pain that gets worse, even after taking pain medicine
- swelling at the incision area
- less appetite or vomiting (throwing up)
Another concern is your baby still vomiting after they go home. Please call your baby's surgeon's office if you notice any of the following:
- vomiting after most meals
- weight loss
- your baby is not urinating (peeing) as much as usual
- your baby feels lethargic or very tired or drowsy
If you have a question or a concern that is not urgent, call your baby's surgeon's office during business hours or leave a message on the answering machine after hours. If you have an urgent concern, take your baby to his family doctor, paediatrician, or the nearest emergency department. In an emergency, call 911.
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