Pyloromyotomy, cutting of pyloric muscle (Fredet-Ramstedt type operation)
CPT4 code
Name of the Procedure:
Pyloromyotomy, also known as Fredet-Ramstedt operation
Summary
Pyloromyotomy is a surgical procedure that involves cutting the muscle of the pylorus, which is the lower part of the stomach that connects to the small intestine. This operation is primarily performed to treat a condition called pyloric stenosis, where the muscle thickens and obstructs the passage of food.
Purpose
The procedure addresses pyloric stenosis. Its goal is to relieve the obstruction caused by the thickened pyloric muscle, allowing food to pass from the stomach to the small intestine properly.
Indications
- Projectile vomiting in infants
- Dehydration and weight loss
- Gastric outlet obstruction noted in diagnostic imaging
- Failure to thrive due to feeding difficulties
Preparation
- Fasting for a specified period before the surgery
- Adjustment or discontinuation of certain medications
- Blood tests and imaging studies to confirm diagnosis and assess the patient's overall health
Procedure Description
- Under general anesthesia, a small incision is made in the abdomen.
- The surgeon exposes the pyloric muscle and makes a longitudinal cut along its length.
- The muscle is then spread apart without cutting through the inner lining of the stomach.
- The incision is closed, and the child is moved to recovery.
Tools and equipment include surgical knives, retractors, and possibly laparoscopic instruments. General anesthesia is always used.
Duration
The procedure typically takes about 45 minutes to 1 hour.
Setting
The operation is usually performed in a hospital's surgical suite.
Personnel
- Pediatric surgeon
- Anesthesiologist
- Operating room nurses
- Surgical assistants
Risks and Complications
Common risks:
- Infection at the incision site
- Vomiting post-operation
Rare risks:
- Injury to the stomach lining
- Bleeding
- Adhesions or scarring
Benefits
The procedure provides immediate relief from vomiting and improves feeding and growth. Benefits are typically seen within a few days post-operation.
Recovery
- Hospital stay of 1-2 days for monitoring
- Gradual reintroduction to feeding
- Instructions on wound care and activity restrictions
- Follow-up appointment with the surgical team
Alternatives
- Balloon dilation (non-surgical, but less commonly used, with variable success rates)
- Medically managing symptoms (rarely effective in severe cases)
Patient Experience
During the procedure, the patient is under general anesthesia and will not feel any pain. Afterward, mild pain at the incision site can be managed with pain relief medications. The child may experience some vomiting initially, but this typically resolves quickly as the stomach adjusts.