Hypertrophic pyloric stenosis (gastric pyloric spasm) is a narrowing in the area of the stomach outlet that leads to impaired passage of the stomach contents into the duodenum. The sphincter muscle (pylorus), which closes off the stomach from the duodenum, remains permanently tense and no longer allows the stomach contents to pass through. The constant cramping leads to a thickening of the muscle over time.

The causes are still unknown. However, hypertrophic pyloric stenosis runs in families and affects a total of 2-3 out of 1000 infants in Western countries. The disease mainly affects first-born boys and boys are affected 10 times more frequently than girls. The typical age is between 3 and 6 weeks.

The "gushy" or "projectile" vomiting is the main symptom of hypertrophic pyloric stenosis. The affected children vomit the milk partially or completely in a gush about half an hour after a meal. The vomit is typically not bilious and not bloody, but after some time, the stomach irritation can lead to threads of blood in the vomit. Immediately after vomiting, your child will be hungry again and look for the breast or bottle. The increasing frequency and intensity of vomiting typically increases over several days. Sometimes increased stomach movements (peristalsis) can be observed on the abdominal surface in the upper abdomen immediately after the meal and the enlarged pylorus can be palpated. Your child is nevertheless constantly hungry and correspondingly unhappy. The pediatrician will typically note weight stagnation or even weight loss and even signs of dehydration.

The symptoms of the condition are typical. The diagnosis is confirmed by means of an ultrasound examination, which makes the thickened muscle at the stomach outlet visible. Treatment consists of surgically widening the constriction by splitting the muscle fibers (the pylorus).

After being referred by your pediatrician, your child will be observed by the experienced ward team of our Clinical Department (pediatric nurses and physicians) and the diagnosis will be confirmed by means of an ultrasound examination, which makes the thickened muscle at the stomach outlet visible. The lack of food intake and repeated vomiting can lead to pronounced imbalances in blood salts (electrolytes) and a lack of fluids (dehydration). Your child's blood will therefore be taken to determine whether the lack of fluids has already led to a typical change in blood salts (electrolytes). It will also initially be necessary to administer fluids by infusion. The operation is not an emergency procedure, so the fluid and electrolyte balance must be stabilized first and foremost. As soon as the electrolytes in your child's blood are balanced by the infusion (this can take up to several days in severe cases), your child must be operated on.

 

 

During the necessary operation, the fibers of the thickened pylorus are split longitudinally (Weber-Ramstedt pyloromyotomy). General anesthesia is always necessary for this operation. Until a few years ago, the operation was performed via a transverse abdominal incision. The development of minimally invasive techniques (laparoscopy) in our Clinical Department is now so advanced that we operate on children with hypertrophic pyloric stenosis exclusively laparoscopically (= minimally invasive). For this, only a small incision is made at the navel (4 mm) and two further incisions (2 mm) on the right and left in the upper abdomen. The thickened pylorus can then be split longitudinally through these incisions using appropriate surgical instruments under optimal visibility.

The result of the operation can be seen quickly. Your child can drink its normal milk again just a few hours after the operation and you can be discharged home within a few days. After just a few weeks, the tiny incisions on the abdomen are barely visible (Fig. 4+5).

As a rule, you will not be routinely referred back to us for a follow-up examination, but will be seen by the colleagues who referred you to us for surgery. All suture material is self-dissolving, so no sutures are required. However, if you still have questions regarding the operation itself or if we consider an earlier follow-up examination with us to be appropriate in individual cases, you can arrange an outpatient appointment at any time