Infantile Hypertrophied Pyloric Stenotis (Ramstedt’s Pyloromyotomy)

After confirmation of the disease by USG abdomen and/or upper G.I. contrast study in a case of projectile non bilious vomiting.

The associated dehydration and electrolytes disturbance is corrected prior to surgery. An infant feeding tube is inserted within the stomach via nostril.

After induction of GA and painting draping a small transverse supraumbilical incision in between Xiphi sternum & umbilical at the right rectus muscle is made. The muscles are divided & after incision peritoneum abdominal cavity is opened. The transverse colon retracted inferiorly and left lobe of liver superiorly to expose the greater curvature of stomach. The pyloric tumor is delivered out and is held in between thumb and index finger. The superomedial aspect is selected for incision as it is the least vascular supplied area of pylorus. The incision is only superficial but incomplete longitudinal length of tumor. The pyloric muscle is splitted by inserting pyloro myotomy forcep (Denis Browne forcep) in its entire longitudinal length protecting underlying mucosa. The patency is checked by instilling saline via infant feeding tube. Oozing from the splitted muscle in checked adequately. The stomach is pushed back within peritoneal cavity and retractors are released. The incision is closed in layers with subcuticular suture for skin.