A 3-week-old male infant presents with non-bilious projectile vomiting after feeds. Examination reveals an olive-shaped mass in the epigastrium. Ultrasound shows pyloric muscle thickness of 5 mm and pyloric channel length of 20 mm. The appropriate surgical procedure is:

• A Ramstedt's pyloromyotomy ✓
• B Pyloroplasty (Heineke-Mikulicz)
• C Gastroduodenostomy (Billroth I)
• D Fundoplication with pyloroplasty

Explanation

Hypertrophic pyloric stenosis is diagnosed when pyloric muscle thickness ≥4 mm and channel length ≥16 mm on ultrasound. Ramstedt's pyloromyotomy (longitudinal split of the pyloric muscle without entering the mucosa) is the definitive surgical treatment, performed after correcting the hypochloraemic metabolic alkalosis with intravenous saline. Laparoscopic pyloromyotomy has equal outcomes to open surgery.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.