pyloric sphincterotomy

Congenital hypertrophic pyloric stenosis is a common disease in the neonatal period, accounting for the third place in the digestive tract malformation, and most of them are full-term children. The success of the treatment of pyloric stenosis is one of the great achievements of surgery in this century. The incidence rate in China is 3. Mostly male, the ratio of male to female is about 4 to 5:1, and even as high as 9:1. More common in the first child, accounting for 40 to 60% of the total number of cases. Treatment of diseases: adult hypertrophic pyloric stenosis congenital hypertrophic pyloric stenosis Indication Infants with congenital pyloric hypertrophic stenosis should be treated with pyloric sphincter incision if they are not treated by non-surgical treatment. Preoperative preparation 1. The sick child is unable to eat for a long time and is accompanied by severe vomiting, often with dehydration and low potassium and low chloride alkalosis. Therefore, the balance of dehydration and electrolyte imbalance must be corrected before surgery. 2. Children with obvious malnutrition and anemia should receive a small amount of blood transfusion before surgery, 20 ml per kilogram of body weight. 3. Give enough vitamin C and intramuscular injection of vitamin E to prevent and treat early neonatal scleredema. 4. Lower stomach tube (fine catheter) on the morning of surgery. 5. Take care to prevent vomiting and suffocation. Surgical procedure 1. Position: supine position, the limbs are wrapped with cotton wool and fixed on the operating table. 2. Incision: Common incisions include a right upper abdomen transverse incision, a 1 cm oblique incision under the right costal margin, or a right upper transabdominal rectus incision. 3. Expose the pylorus: cut the abdominal wall, enter the abdominal cavity, use the thumb and finger to pinch the stomach to the left and pull to the left, you can see the thick, pale pyloric tube. 4. Open the pyloric sphincter: use the left thumb and index finger to pinch the thick pyloric tube, the right hand with a small round knife in the avascular zone of the anterior wall of the hypertrophic pyloric tube, and cut the serosa, pyloric longitudinal muscle and large along the longitudinal axis. The circumflex muscle, that is, the submucosal layer and the mucosa layer swell slightly. Be careful not to cut too deep, so as not to cut through the gastric mucosa and enter the stomach cavity, especially at the duodenal end, the most easy to cut the mucosa, should be careful. Use a small curved mosquito hemostat, with the tip of the forceps facing up, carefully separate the uncut ring muscles, and pick up the fine mesh cords of the loop muscle fibers one by one, then cut off, so that the submucosa and mucosa are perfectly oriented. The pyloric tube bulges at the rupture and completely relieves the pyloric obstruction. When the muscle incision oozes, it can be stopped by pressing with hot saline gauze for several minutes. If there is still bleeding, it can be sutured with a thin thread. After returning the pylorus to the abdominal cavity, the abdominal wall is sutured layer by layer.

The material in this site is intended to be of general informational use and is not intended to constitute medical advice, probable diagnosis, or recommended treatments.