Ramstedt pyloromyotomy

Why are we operating?

Splitting the overgrown pyloric muscle down to (never through) the mucosa, for the hungry vomiting baby; the emergency beforehand is the chemistry, not the surgery.

Indication: Infantile hypertrophic pyloric stenosis, after full correction of the hypochloraemic alkalosis.

The operation in 4 steps

1. 01Fluid and electrolyte correction first

   Surgery waits until chloride, bicarbonate and potassium are corrected with saline and added potassium.

2. 02Access

   Laparoscopic ports (or a small open incision); the olive-shaped pylorus is identified and steadied.

3. 03The myotomy

   The serosa and muscle are incised along the avascular front of the pylorus and the fibres split bluntly until mucosa bulges into the cleft, stopping short of the duodenal end.

4. 04Leak check and early feeding

   Air insufflated via the nasogastric tube checks the mucosa is intact; feeds restart within hours.

Anatomy you need

The stomach narrowing into the pylorus; the hypertrophied ring is split down to mucosa and no further.

What can go wrong

• Surgical-site infection

  Wound erythema, warmth, discharge, and pain out of proportion, typically from postoperative day 4–7.