Hypertrophic Pyloric Stenosis: Management

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.