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.