Digestive Health: Minimally Invasive Surgery for Pyloric Stenosis in Infants
Guest: Dr. Christian Streck – Department of Surgery, MUSC
Host: Dr. Linda Austin – Psychiatry, MUSC
Dr. Linda Austin: I’m Dr. Linda Austin. I’m interviewing Dr. Chris Streck. Dr. Streck is Assistant Professor of Pediatric Surgery at the Medical University of South Carolina. He’s a specialist at MUSC Children’s Hospital in the laparoscopic surgical treatment of diseases in children. Dr. Streck, let’s talk about a procedure that you do fairly commonly, I understand, which is the repair of pyloric stenosis. What is pyloric stenosis?
Dr. Christian Streck: That’s a great question. It’s a complex-sounding term, but it’s, really, a pretty simple idea. The pylorus is a muscle that’s developed at the end of the stomach. So, typically when a child, or anyone, eats, the food is swallowed. It goes down their esophagus; sometimes, we call it a swallowing tube, and into the stomach, where the food is processed. The pylorus is the muscle that’s at the opening of the stomach, so that food, once it’s processed in the stomach, goes through the pylorus, into the rest of the small intestine, and into the colon. In patients with pyloric stenosis, the muscle around that opening in the stomach becomes so thickened that food cannot pass through, so the child is forced to vomit when the stomach fills up with food after a meal.
Dr. Linda Austin: Is that what they used to call projectile vomiting?
Dr. Christian Streck: Yes. So, as the child, who is obviously very hungry because food is not allowed to pass through, tries to feed more and more, the stomach becomes more distended because of the obstruction. And, eventually, what happens is very forceful vomiting, which looks like the formula or breast milk that they’ve just finished.
Dr. Linda Austin: Now, hundreds of years ago, before there was surgery, what would happen to those children?
Dr. Christian Streck: Well, unfortunately, those children often died from malnutrition. There were probably a few that were able to get by, maybe, with less of a degree of obstruction. But, for the most part, those children didn’t survive.
Dr. Linda Austin: And, this is not an uncommon problem, correct?
Dr. Christian Streck: This is fairly common. It’s something that we see here at MUSC. There are probably three to five patients a week that we have to operate on for pyloric stenosis, so it is relatively common.
Dr. Linda Austin: So, describe the procedure. How do you fix this?
Dr. Christian Streck: Sure. Well, the traditional approach has been an incision over the upper right part of the abdomen, just above the bellybutton. What was done was division of the skin and all the muscle layers to get into the abdomen and actually lift the stomach up through the abdominal wall. And, the muscle at the end of the stomach, the pylorus muscle, is divided with a knife and split open. And, that splitting of the muscle; once the muscle pops open, allows food to empty from the stomach into the rest of the bowel.
What’s different about the management of pylorus stenosis here at Children’s Hospital is that all of the surgeons are employing a laparoscopic, or minimally invasive, approach. And what’s really nice about the minimally invasive approach is that we have one very small incision beneath the umbilicus, or bellybutton, that’s less than the size of the tip of typical pinky fingernail, and two other even smaller incisions in the abdominal wall, to allow placement of tiny instruments. We’re able, using a camera or scope, to look inside the abdomen and see the thickened muscle, and actually divide it with these very small incisions. And, often, we can do this surgery between 20 and 30 minutes.
Dr. Linda Austin: That’s amazing. And, how long, then, does the baby have to stay in the hospital?
Dr. Christian Streck: The great thing about surgery in general, particularly surgery for these patients with pyloric stenosis, is that once the surgery is done, they’re essentially cured. So, often, these children have been vomiting for days or even, sometimes, weeks, until the diagnosis is made. Within two hours of surgery, they start on feeds and, usually, within 24 hours, they’re able to go home eating a normal amount of formula.
Dr. Linda Austin: It must feel like a miracle to the parents.
Dr. Christian Streck: I think it does. The parents are always very happy. And it makes our job very satisfying.
Dr. Linda Austin: I bet it does. It’s something that no so long ago was potentially fatal, and is so quickly remedied now. It’s unbelievable.
Dr. Christian Streck: Yeah. It really is.
Dr. Linda Austin: Now, is this procedure widely available throughout South Carolina and the Southeast?
Dr. Christian Streck: It’s not. You know, laparoscopic techniques have been around since, probably, the 1980s; mostly used in adult patients. The laparoscopic approach to pyloric stenosis is really something that’s only become readily available in the last few years. And MUSC is the only center in the region, and one of the very few centers in the state, where the laparoscopic approach is being employed. And, overall, the highest volume of this type surgery, using the laparoscopic technique, is being done here at MUSC, as compared to the rest of the state.
Dr. Linda Austin: Very exciting. We’re so glad to have you here.
Dr. Christian Streck: Thank you.
Dr. Linda Austin: Thanks for talking with us today.
Dr. Christian Streck: Sure.
If you have any questions about the services or programs offered at the Medical University of South Carolina, or if you’d like to schedule an appointment with one of our physicians, please call MUSC Health Connection at: (843) 792-1414