Once we've diagnosed
hypertrophic pyloric stenosis,
how do we manage the patient?
very high yield.
You should remember this.
Correct the electrolyte abnormalities first.
If you're tempted to go
to the operating room first,
the patient may actually have
significant respiratory complications postoperatively.
alkalosis due to the projectile vomiting
is associated with postoperative apnea.
Babies do not have a
significant wiggle room,
any period of postoperative apnea
can lead to death.
Here’s surgery, my favorite part,
Whether it’s done open or laparoscopic,
although when baby is opened,
it’s just with a tiny little incision.
The pyloric channel is exposed
like on the left side of the screen.
And on the right side of the screen,
the pyloric channel has been opened
down to the level of the mucosa.
Notice already that there's much more
of a generous pyloric channel.
Be careful, though.
Make sure you don't go full-thickness.
Look at the baby now.
this is the part I was
describing as quite rewarding.
Babies can be fed almost
right away after surgery.
Intolerance of feeds,
the initial few times,
is absolutely normal.
Give them some time.
Sometimes there’s a little
bit of postoperative swelling.
Now, let's review some
important clinical pearls
and high-yield information.
electrolyte disturbances are very
important to correct prior to surgery.
You do not want
postoperative apnea in your baby
in an otherwise very,
very well-tolerated surgery.
For your examination,
vomiting in pyloric stenosis is non-bilious
due to its inability to mix
with bile in the duodenum.
not all non-bilious emesis is
due to hypertrophic pyloric stenosis.
Thank you very much for joining me
on this discussion of hypertrophic pyloric stenosis.