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Neonatal Surgical Conditions
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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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
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Association between Elevated Urine Neutrophil Gelatinase-Associated Lipocalin and Postoperative Acute Kidney Injury in Neonates
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Objective: To examine the incidence of postoperative neonatal acute kidney injury (AKI) following general surgical procedures and to test the hypothesis that postoperative urine neutrophil gelatinase-associated lipocalin (uNGAL) concentrati
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Pyloric Stenosis with Dr. Alex Bondoc
Pyloric stenosis incidence is approximately 4 to 5 in 1000 live births with heavy male preponderance.
epidemiologicalAlex Bondoc3:05 ↗
A 2017 Journal of Pediatric Surgery study of 584 patients found African American infants with pyloric stenosis presented with higher bicarbonate and lower chloride levels.
Host summaryEm Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position3:24 ↗
Uninsured families' babies had lower chloride and higher bicarbonate levels at presentation and longer times between diagnosis and OR.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position3:44 ↗
A large-scale Denmark and Holland study found pyloric stenosis is 87% heritable.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:13 ↗
Researchers have identified a molecular diagnostic marker and can trace specific genetic changes indicating risk for pyloric stenosis.
Host summaryEm Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position4:25 ↗
Ultrasound diagnostic criteria: muscle thickness greater than 4 millimeters and pyloric channel length greater than 15 millimeters suggest pyloric stenosis.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position6:23 ↗
A 2008 and 2016 Journal of Pediatric Surgery study identified specific fluid resuscitation pathways that reduced blood draws and did not delay time to surgery.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position6:46 ↗
Recommended fluid resuscitation: isotonic saline bolus followed by maintenance IV fluids (D5 half-normal saline with 20 mEq/L potassium chloride).
Host summaryEm Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position7:04 ↗
Nasogastric decompression should be avoided to prevent exacerbation of metabolic alkalosis.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position7:18 ↗
Atropine is traditional medical management but has fallen out of favor because pediatric anesthetists are skilled and there is low concordance between congenital anomalies creating high anesthetic risk.
opinionAlex Bondoc7:34 ↗
A 2023 Journal of Pediatric Surgery study suggests antibiotic prophylaxis may be unnecessary for pyloromyotomy and may carry unnecessary long-term side effects.
Host summaryEm Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position8:12 ↗
The first pyloromyotomy was performed the year before Ramstedt, who popularized it using a coffee spoon, intending pyloroplasty but performing only myotomy when the baby became unstable.
clinicalAlex Bondoc8:40 ↗
Gastric suction in three positions (head down, right, left) while awake is performed before induction to prevent aspiration from the atonic stomach.
clinicalAlex Bondoc9:16 ↗
For laparoscopic pyloromyotomy, 3-millimeter instruments are used through three incisions: umbilicus, right upper quadrant, and left upper quadrant.
clinicalAlex Bondoc10:12 ↗
The 3-millimeter Maryland grasper when fully opened is 13 millimeters, so a 13mm myotomy on a 15-18mm channel will be incomplete.
clinicalAlex Bondoc10:57 ↗
To assess myotomy completeness, both ends of separated muscle should move independently; resistance or connected movement indicates incomplete myotomy.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position11:49 ↗
Air can be insufflated down a suction catheter to look for bubbles indicating mucosal perforation.
clinicalAlex Bondoc12:05 ↗
Omentum is placed on top of the myotomy site.
clinicalAlex Bondoc12:20 ↗
Open pyloromyotomy can be performed through a periumbilical incision with tunneling up to the right upper quadrant, taking advantage of babies' stretchable skin.
clinicalAlex Bondoc12:27 ↗
Incisional hernias can occur because fascia is typically not closed on stab incisions in upper quadrants; omental hernias have been observed.
clinicalAlex Bondoc13:06 ↗
Complication rates after pyloromyotomy are equivalent or better with open approach because laparoscopic pyloromyotomy is an experience and feel operation.
opinionAlex Bondoc13:23 ↗
Post-operative vomiting is very common and does not necessarily mean the operation did not work; the atonic stomach does not remodel immediately.
clinicalAlex Bondoc13:54 ↗
Complete intolerance of feeds lasting into days post-operatively raises concern for incomplete myotomy.
clinicalAlex Bondoc14:13 ↗
A flexible feeding protocol (reducing volume if baby vomits 6 times but continuing smaller feeds and increasing as tolerated) decreases length of hospital stay.
Host summaryEm Gootee summarizes what Dr. Alex Bondoc said — not the host's own clinical position14:30 ↗
Studies on adults who had pyloromyotomy as children show they do not have major issues like nausea, vomiting, reflux, or other GI problems later in life, and long-term follow-up is usually not necessary.
Host summaryKim Priban summarizes what Dr. Alex Bondoc said — not the host's own clinical position15:08 ↗
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