by Mahnke D
(Pyloric Stenosis Repair; Pyloromyotomy)

How to Say It: py-LOR-oh-plah-stee, py-LOR-ik stuh-NOH-sis, py-LOR-oh-MY-ah-ta-me

Definition

Pyloroplasty widens the opening between the stomach and the small intestines. This area is called the pylorus. The pyloric sphincter is a muscle layer that surrounds this area. It helps to widen or close the opening.

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Reasons for Procedure

The pylorus can narrow enough to cause problems moving food from stomach to intestines. This is called pyloric stenosis . It may be caused by:

  • Scarring from ulcers
  • A hiatal hernia
  • Inflammatory diseases
  • A mass, such as cancer
    • It can lead to nausea, vomiting, anddehydration . It can cause serious problems with moving and digesting food. Pyloroplasty is done to reopen the pylorus.

    Possible Complications

    Problems are rare, but all procedures have some risk. Your doctor will go over some problems that could happen, such as:

    • Bleeding
    • Infection
    • Damage to intestines
    • Intestines come out of the incision site (hernia)
    • Chronic diarrhea

    Things that may raise the risk of problems are:

    • Smoking
    • Drinking too much alcohol
    • Having chronic disease such as diabetes or obesity

    What to Expect

    Prior to Procedure

    The surgical team may meet with you to talk about:

    • Anesthesia options
    • Any allergies you may have
    • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
    • Fasting before surgery, such as avoiding food or drink after midnight the night before
    • Whether you need a ride to and from surgery
    • Specialists you may need to see
    • Tests that will need to be done before surgery

    Anesthesia

    This surgery is done with general anesthesia . You will be asleep.

    Description of Procedure

    An incision will be made in the upper part of your belly wall and muscles. A cut will be made in the muscle of the pylorus. The muscle will then be sewn back together in a way that will make the opening wider. The belly muscles will be sewn back together. The skin will be closed with stitches or staples.

    If your pyloroplasty is done because you have an ulcer, other procedures may be done at the same time.

    Doctors can also use other ways to reach and cut the pylorus:

  • Laparoscopy uses small incisions in the belly. A small camera and other tools through these cuts and fix the pylorus muscle.
  • Endoscopy uses a scope that is passed down the throat.

    • Both of these can reduce the risk of infections or other problems.

    Immediately After Procedure

    After the surgery, you will be monitored in a recovery area for about 1 to 2 hours.

    How Long Will It Take?

    1 to 2 hours

    Will It Hurt?

    Anesthesia will prevent pain during surgery. Medicine and self care can help with the pain after.

    Average Hospital Stay

    The usual length of stay is 1 to 3 days. If you have any problems, you may need to stay longer. If the surgery was done with endoscopy or laparoscopy, you may go home sooner.

    Post-procedure Care

    At the Hospital

    You will gradually return to a normal diet. Before you go home, you will be taught how to care for your surgical incision.

    Preventing Infection

    During your stay, the staff will take steps to reduce your chance of infection such as:

    • Washing their hands
    • Wearing gloves or masks
    • Keeping your incisions covered

    There are also steps you can take to reduce your chance of infection such as:

    • Washing your hands often and reminding visitors and staff to do the same
    • Reminding staff to wear gloves or masks
    • Not allowing others to touch your incision

    You will need to avoid hard activities or lifting things that weigh more than 10 pounds for 4 to 6 weeks. You may also have to only have liquids at first and then slowly start eating solid foods.

    Problems to Look Out For

    Call your doctor if you are not getting better or you have:

    • Signs of infection, such as fever and chills
    • Redness, swelling, increasing pain, excessive bleeding or any discharge from the incision site
    • Nausea or vomiting that will not go away
    • Pain that you cannot control with the medicines given
    • Cough, shortness of breath, or chest pain
    • Severe abdominal pain or vomiting blood
    • Dark-colored, tarry stools (poop) or blood in the stool

    If you think you have an emergency, call for medical help right away.

    RESOURCES

    American College of Surgeons   http://www.facs.org

    Family Doctor—American Academy of Family Physicians  https://familydoctor.org 

    CANADIAN RESOURCES

    Canadian Association of Gastroenterology  https://www.cag-acg.org 

    Health Canada  https://www.canada.ca 

    References

    Discharge instructions for abdominal surgery. Saint Luke’s website. Available at https://www.saintlukeskc.org/health-library/discharge-instructions-abdominal-surgery. Accessed March 4, 2022.

    Gastroparesis. Cleveland Clinic website. Available at: https://my.clevelandclinic.org/health/diseases/15522-gastroparesis. Accessed March 4, 2022.

    Hypertrophic pyloric stenosis. EBSCO Dyna Med website. Available at: https://www.dynamed.com/condition/hypertrophic-pyloric-stenosis. Accessed March 4, 2022.

    Pyloroplasty. Mount Sinai web site. Available at: https://www.mountsinai.org/health-library/surgery/pyloroplasty. Accessed March 4, 2022.

    Uemura, K.L., Chaves, D., et al. Peroral endoscopic pyloromyotomy for gastroparesis: a systematic review and meta-analysis. Endoscopy International Open, 2020; 8(7): E911-E923.

    Revision Information

    • Reviewer: EBSCO Medical Review Board Daus Mahnke, MD
    • Update Date: 03/00/2022