Hypertrophic Pyloric Stenosis (HPS) in Infancy

Gastric outlet obstruction requires decompression with a gastric tube placed either through the nose (NG) or the mouth. A shallow longitudinal incision is made just through the serosa. The duodenum is closest to the serosa immediately adjacent to the pylorus, so it is prudent to begin the incision 2 mm proximal to its junction with the stomach. The incision extends well onto the antrum, a distance of about 2 cm. There is a path for the incision free of visible vessels over the anterior aspect of the pylorus and antrum. A blunt scalpel handle or the serrated edge of one jaw of a clamp is appropriate to begin splitting the muscle. Once the muscle begins to divide the muscularis is split to the level of the submucosa. The major technical pitfall is mucosal perforation at the duodenal–pyloric junction.