Treatment algorithm

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

all patients

1st line – intravenous fluid resuscitation

Back
ACUTE
|
all patients
1st line – 

intravenous fluid resuscitation

Fluid and electrolyte replacement is paramount to successful management. Surgery must be delayed until hypovolaemia and electrolyte disturbances are corrected. If alkalosis is not corrected, it will prolong the risk for postoperative depression of respiratory drive.

Severely volume-depleted patients should receive a bolus of normal saline prior to initiating fluid replacement.

Intravenous fluid replacement should be provided at 1.5 times maintenance rate with 5% dextrose plus 0.45% saline.

Intravenous fluid should not contain potassium until the urine output is adequate (1-2 mL/kg/hour). Once adequate, 10 to 20 mEq/L KCl should be added.

Surgery can proceed once the serum bicarbonate levels are <28 mmol/L (<28 mEq/dL) and chloride levels are >95 mmol/L (>95 mEq/dL).[1][72]

Plus – pyloromyotomy

Back
ACUTE
|
all patients
Plus – 

pyloromyotomy

Treatment recommended for ALL patients in selected patient group

Hypovolaemia and electrolyte disturbances must be corrected prior to definitive surgical management.

Pyloromyotomy corrects the gastric outlet obstruction created by the hypertrophied pylorus.[Figure caption and citation for the preceding image starts]: Laparoscopic port placement.From the collection of Dr Jeffrey S. Upperman; used with permission [Citation ends].com.bmj.content.model.Caption@7936d6b3[Figure caption and citation for the preceding image starts]: Laparoscopic knife pyloric incisionFrom the collection of Dr Jeffrey S. Upperman; used with permission [Citation ends].com.bmj.content.model.Caption@55ed9a13[Figure caption and citation for the preceding image starts]: Muscle-splitting manoeuvreFrom the collection of Dr Jeffrey S. Upperman; used with permission [Citation ends].com.bmj.content.model.Caption@2822fb9b

Laparoscopic and open techniques have been reported to have similar risks, although the laparoscopic approach may increase the risk of mucosal perforation (RR 1.60, 95% CI 0.49 to 5.26), and incomplete pyloromyotomy (RR 7.37, 95% CI 0.92 to 59.11), compared with the open approach.[60][61][62][63][64]

Laparoscopic pyloromyotomy was associated with shorter postoperative recovery time and fewer analgesia requirements than open pyloromyotomy in one large, multicentre international trial.[66]

In centres where laparoscopic surgery is readily performed, it may be the preferred approach.

As most infants with pyloric stenosis are otherwise healthy, there is no preference to perform open versus laparoscopic pyloromyotomy in different patient subsets based on comorbidities.

back arrow

Choose a patient group to see our recommendations

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer

Use of this content is subject to our disclaimer