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Pyloric Stenosis
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Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
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Postoperatively, Haight gave rectal sulfathiazole (an antibiotic), which was considered inadequate by modern standards (antibiotics should be given before incision, not after). — Todd Ponsky, History of Pediatric Surgery · 47:10
History of Pediatric Surgery
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An interactive discussion between Todd Ponsky, MD and Don Nakayama, MD about the history of pediatric surgery, specifically the evolution of the management of pyloric stenosis, Hirschprung disease and esophageal atresia. Dr. Nakayama is an
podcast52:36 · Dec 2020
The air insufflation test is less important than direct visualization for confirming mucosal integrity. Laparoscopic Pyloromyotomy · 6:30
Laparoscopic Pyloromyotomy
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video7:19 · Feb 2020
Peritoneal Access
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At the 7th Annual Pediatric Surgery Update Course, Dr. Carroll "Mac" Harmon reviews rapid fire cases with a focus on peritoneal access.
video · Mar 2020
Traditional ATLS teaching was to give two 20cc/kg boluses of crystalloid before giving blood, but this is now changing to earlier blood administration. — Todd Ponsky, Todd Ponsky: What is new in Pediatric Surgery? Teaser · 23:53
Hot New Topics from The Journal Of Pediatric Surgery: Update Course 2017
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At the 5th Annual Stay Current Pediatric Surgery Update Course in 2017, Dr. George "Whit" Holcomb and Dr. Todd Ponskydiscuss hot new topics from the Journal of Pediatric Surgery. He focuses on spontaneous or traumatic pneumomediastinum eval
video27:37 · Sep 2018
RCT for Feeding after Pyloromyotomy
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Dr. Alejandra Casar Berazaluce reviews feed advancement post-pyloromytomy, as she summarizes "A randomized trial to assess advancement of enteral feedings following surgery for hypertrophic pyloric stenosis" from the Journal of Pediatric Su
video · May 2020
Todd Ponsky: What is new in Pediatric Surgery? Teaser
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video1:05:21 · Jun 2026
Complication rates after pyloromyotomy are equivalent or better with open approach because laparoscopic pyloromyotomy is an experience and feel operation. — Alex Bondoc, Pyloric Stenosis with Dr. Alex Bondoc · 13:23
Pyloric Stenosis with Dr. Alex Bondoc
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In this episode, we review the symptoms, diagnosis and management of pyloric stenosis with Dr. Alex Bondoc, pediatric surgeon from Cincinnati Children's.
Host: Em Gootee, Kim Priban
Key Topics Covered:
Common Diagnoses: Explo
podcast16:20 · Jun 2024
Patients go to the OR for pyloromyotomy once their bicarb level is less than 30, their chloride is greater than 100, and their potassium is normal. — Meera Kotagal, Pyloric Stenosis Guideline Recap · 3:00
Pyloric Stenosis
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Dr. Bhargava Mullapudi, Pediatric Surgeon at Cincinnati Children’s, and Dr. Gillian Goddard, Pediatric Surgery Research Fellow at Cincinnati Children's, joins Dr. Rae Hanke to review the essentials of pyloric stenosis in this videocast.Pylo
video12:30 · May 2020
Pyloric Stenosis Guideline Recap
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Dr. Meera Kotagal discusses the preoperative and post-operative management of pyloric stenosis. These guidelines are currently followed at Cincinnati Children's Hospital (January 2019) as guided by the following studies:Dalton BGA, et al. O
video · Aug 2022
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Pyloric Stenosis
Pyloric stenosis is hypertrophy and hyperplasia of the inner circular layer with associated mucosal hypertrophy
clinicalBhargava Muliudi0:31 ↗
Pyloric stenosis leads to gastric outlet obstruction in infants between 2 to 10 weeks of age
clinicalBhargava Muliudi0:37 ↗
Pyloric stenosis is more common in males
epidemiologicalBhargava Muliudi0:46 ↗
There is increased risk for first born infants with a positive family history
epidemiologicalBhargava Muliudi0:49 ↗
Patients with pyloric stenosis typically present with non-bilious vomiting, usually seen between 2 to 10 weeks of life
clinicalBhargava Muliudi1:04 ↗
Infants with pyloric stenosis are otherwise well appearing and hungry after vomiting
clinicalBhargava Muliudi1:12 ↗
Emesis in pyloric stenosis will progress until it is projectile
clinicalBhargava Muliudi1:16 ↗
Hyperbilirubinemia can occur in up to 14% of patients with pyloric stenosis due to downregulation of hepatic enzymes associated with starvation
clinicalBhargava Muliudi1:24 ↗
Bilious emesis should always be worked up to rule out intestinal malrotation with midgut volvulus
guidelineBhargava Muliudi2:00 ↗
Ultrasound is the gold standard for diagnosing pyloric stenosis
clinicalBhargava Muliudi2:50 ↗
Pyloric stenosis is diagnosed on ultrasound when pyloric muscle is 3 millimeters thick and 14 millimeters long or greater
clinicalBhargava Muliudi2:55 ↗
The classic electrolyte abnormality in pyloric stenosis is hypochloremic, hypokalemic, metabolic alkalosis
clinicalBhargava Muliudi3:19 ↗
Prolonged gastric outlet obstruction leads to persistent vomiting and loss of hydrochloric acid, which leads to hypochloremia and loss of protons leading to metabolic alkalosis
clinicalBhargava Muliudi3:29 ↗
The kidneys compensate for dehydration by increasing the activity of the sodium potassium pump to retain fluid, leading to urinary excretion of potassium to preserve sodium and water
clinicalBhargava Muliudi3:41 ↗
In later stages of pyloric stenosis, excretion of protons leads to paradoxical aciduria, which further worsens metabolic alkalosis
clinicalBhargava Muliudi3:56 ↗
In the US, pyloromyotomy is the standard of care for pyloric stenosis
guidelineBhargava Muliudi4:17 ↗
In some countries, atropine is used as a non-surgical option for pyloric stenosis, with a success rate of about 60 to 90%
clinicalBhargava Muliudi4:22 ↗
Cincinnati Children's follows a resuscitation protocol published by the Children's Mercy Group in Kansas City for pyloric stenosis
guidelineBhargava Muliudi4:41 ↗
If chloride is less than 85, give 3 boluses separated by an hour and then recheck labs
guidelineBhargava Muliudi5:01 ↗
If chloride is between 85 and 97, give two boluses
guidelineBhargava Muliudi5:10 ↗
If chloride is greater than 97, give 1 bolus
guidelineBhargava Muliudi5:15 ↗
If bicarbonate is greater than 40, give 3 boluses
guidelineBhargava Muliudi5:24 ↗
If bicarbonate is greater than or equal to 33, give 2 boluses
guidelineBhargava Muliudi5:29 ↗
Prior to going to the operating room, serum chloride must be corrected to greater than 100 and bicarbonate to less than 30
guidelineBhargava Muliudi5:48 ↗
The proximal edge of the pylorus can be easily identified as the antrum transitions to a thick pylorus
clinicalBhargava Muliudi7:00 ↗
The distal extent of the pyloromyotomy is generally to the crossing vein of Mayo or the white line, which marks the pyloroduodenal junction
clinicalBhargava Muliudi7:07 ↗
After the pyloromyotomy is completed, the submucosa should bulge into the myotomy site
clinicalBhargava Muliudi8:18 ↗
After adequate pyloromyotomy, each side of the pylorus should move independently
clinicalBhargava Muliudi8:25 ↗
Complications from pyloromyotomy include incomplete myotomy, mucosal perforation, aspiration, wound infection, and incisional hernias
clinicalBhargava Muliudi8:42 ↗
There is a slight increased risk of incomplete myotomy and perforation with a laparoscopic approach, but the overall low incidence of complications decreases the clinical significance of the differences between the two approaches
clinicalBhargava Muliudi8:52 ↗
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