Pediatric Hypertrophic Pyloric Stenosis Follow-up

Updated: Jul 26, 2017
  • Author: Hisham Nazer, MBBCh, FRCP, DTM&H; Chief Editor: Carmen Cuffari, MD  more...
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Follow-up

Further Outpatient Care

Infants generally recover rapidly after operative correction of hypertrophic pyloric stenosis. Advise parents to increase food volume in the days after discharge. A single postoperative visit 1-2 weeks after surgery is often all that is necessary to document weight gain. Long-term sequelae from pyloromyotomy are virtually unheard of. Studies have documented normal function returns in months to years after surgery.

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Further Inpatient Care

Infants can be discharged from hospital care once they can remain hydrated and have adequate enteral intake.

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Inpatient & Outpatient Medications

Postoperative analgesics are used as with any other surgical patient. Once oral intake has resumed, acetaminophen usually suffices.

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Complications

The following complications are noted:

  • Undetected mucosal perforation: Perform a diligent search for mucosal transgressions at the time of operation and examine the infant again before initiating feedings. In those rare cases where a perforation was not detected, the infant develops fever, tenderness in the abdomen, and abdominal distention. Return to the operating room if perforation is suspected.

  • Bleeding: In most instances, venous oozing from the myotomy site is self-limited and is not a concern in the postoperative period. Reports of continued bleeding are exceedingly rare but can occur, especially in children with undetected coagulopathy.

  • Persistent vomiting: Incomplete pyloromyotomy is rare in the hands of an experienced pediatric surgeon and usually presents as persistent vomiting until after the second week postsurgery. This problem is confounded when repeat studies performed after surgery provide a confusing picture. Patient observation resolves the problem in most cases.

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