Hypertrophic Pyloric Stenosis: Management

by Kevin Pei, MD

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    00:01 Once we've diagnosed hypertrophic pyloric stenosis, how do we manage the patient? Very important, very high yield.

    00:09 You should remember this.

    00:11 Correct the electrolyte abnormalities first.

    00:14 If you're tempted to go to the operating room first, the patient may actually have significant respiratory complications postoperatively.

    00:22 Remember, alkalosis due to the projectile vomiting is associated with postoperative apnea.

    00:30 Babies do not have a significant wiggle room, and therefore, any period of postoperative apnea can lead to death.

    00:40 Here’s surgery, my favorite part, a pyloromyotomy.

    00:45 Whether it’s done open or laparoscopic, although when baby is opened, it’s just with a tiny little incision.

    00:51 The pyloric channel is exposed like on the left side of the screen.

    00:56 And on the right side of the screen, the pyloric channel has been opened down to the level of the mucosa.

    01:02 Notice already that there's much more of a generous pyloric channel.

    01:06 Be careful, though.

    01:07 Make sure you don't go full-thickness.

    01:13 Look at the baby now.

    01:14 Postoperatively, this is the part I was describing as quite rewarding.

    01:20 Babies can be fed almost right away after surgery.

    01:23 Intolerance of feeds, the initial few times, is absolutely normal.

    01:27 Give them some time.

    01:29 Sometimes there’s a little bit of postoperative swelling.

    01:33 Now, let's review some important clinical pearls and high-yield information.

    01:38 Remember, electrolyte disturbances are very important to correct prior to surgery.

    01:43 You do not want postoperative apnea in your baby in an otherwise very, very well-tolerated surgery.

    01:51 For your examination, remember, vomiting in pyloric stenosis is non-bilious due to its inability to mix with bile in the duodenum.

    02:00 But, remember, not all non-bilious emesis is due to hypertrophic pyloric stenosis.

    02:09 Thank you very much for joining me on this discussion of hypertrophic pyloric stenosis.

    About the Lecture

    The lecture Hypertrophic Pyloric Stenosis: Management by Kevin Pei, MD is from the course Special Surgery.

    Included Quiz Questions

    1. Correct electrolyte abnormalities
    2. Correct metabolic acidosis
    3. Give H2 receptor blocker
    4. Laparoscopic pyloromyotomy
    5. Open pyloromyotomy
    1. Pyloromyotomy
    2. Partial gastrectomy
    3. Sleeve gastrectomy
    4. Bariatric surgery
    5. Roux-en-y bypass

    Author of lecture Hypertrophic Pyloric Stenosis: Management

     Kevin Pei, MD

    Kevin Pei, MD

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