Patient name:
Patient number:
Hospital: University District HospitalTraumaUniversity Pediatric HospitalHospital Oncologico / Ward: Bed No:
Preoperative Diagnosis: Hypertrophic Pyloric Stenosis
Surgeon: / First Assistant: / Second Assistant:
Date of Operation: / Tissue Removed Yes No
Operation: Pyloromyotomy (CPT 43520)
Postoperative Diagnosis: Hypertrophic Pyloric Stenosis (ICD-9 750.5)
Clean Clean Contaminated Dirty Contaminated
Findings: Hypertrophic pyloric muscle
Procedure: Under GETA and use of Magnification 3.5X the baby umbilicus prep and draped using sterile techniques. The deep forrows of the navel were scrapped & cleaned meticolously with the help of applicators.
A supra-periumbilical cosmetic incision was utilized to open the skin. A subcutaneous dissection and proximal flap created for several centimeters above the incision to open the abdominal fascia in the midline. The fascia was opened with the help of a needle point cautery from the upper base of the navel cephalad in the midline taking care to observe and preserve the falciform ligament to the right of the incision. The peritoneum was opened and the incision dilated with the help of army-navy retractors to obtain adequate exposure. The greater curvature of the stomach was identified and brought to the wound area in order to bring the pyloric muscle out through the incision. The pyloric muscle was rotated clockwise and an the anterosuperior portion exposed. A long myotomy incision with a new #12 blade was made starting from the antrum to short of the pyloro-duodenal border by 2 mm separating the muscle fibers with the help of a local constructed myotome until the submucosa was exposed and could be seen bulging above a coronal plane of the serosa. No macroscopic evidence of perforation was seen grossly. Next the pyloric muscle was returned to the abdominal cavity and gauze pressure obtained for hemostatic purposes. Once no bleeding was appreciated the midline fascia was closed using a single layer continous technique with medium size bites using Vycryl 2-0 RB1 needle. The subcutaneous tissue was aproximated with interrupted vycryl 4-0 RB1 needle as needed to avoid a seroma formation. The skin was aproximated using interrupted plain 5-0 PS-3 with five sutures reconstructing the navel properly.
EBL - 2 ml aprox
Drains - none
Postoperative complications - none
Patient tolerated procedure well and was transfered to Recovery Room (PACU) for inmediate monitoring under anesthesia tutelage.
Humberto Lugo-Vicente MD
Lic 7214
NPI 1285602987
REPORT OF OPERATION