A 3-week-old male infant presents with non-bilious projectile vomiting after every feed. On examination, a palpable olive-shaped mass is felt in the epigastrium. Ultrasound confirms pyloric muscle thickness of 5 mm and pyloric channel length of 20 mm. The Fredet-Ramstedt pyloromyotomy involves:

• A Longitudinal incision through the pyloric serosa, muscularis, and mucosa (full-thickness)
• B Transverse incision of the pyloric ring followed by longitudinal closure (Heineke-Mikulicz)
• C Longitudinal incision through the pyloric serosa and muscularis only, stopping at the mucosa to allow it to bulge, without entering the lumen ✓
• D Balloon dilation of the pyloric channel under fluoroscopic guidance

Explanation

The Ramstedt (Fredet-Ramstedt) pyloromyotomy involves a longitudinal incision through the serosa and hypertrophied circular muscle layer along the avascular anterior surface of the pylorus, stopping at — but not through — the mucosa. The muscle is then bluntly spread until the mucosa bulges freely. Inadvertent mucosal perforation (most commonly on the duodenal side) is the key intraoperative complication. Laparoscopic pyloromyotomy has equivalent outcomes to open repair.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.