Carefully avoid undue stretch on the pyloric mucosa or injudicious transgression of the duodenum. Completion of the myotomy well onto the gastric antrum will assure success. Search for mucosal tears or perforations and correct with fine absorbable suture, if found. Avoid use of electrocautery as most bleeding from the myotomy is venous and will remit when the pylorus is returned to its normal position. Perforation of the mucosa should be a rare event.
Some surgeons repair the mucosal defect and cover the area with a small finger of omentum.
Other surgeons opt to close the myotomy and create a secondary myotomy 180 distant from the previous site. Laparoscopic pyloromyotomy can be performed with a small caliber pyloromyotomy knife and spreader. Although this technique has some enthusiastic proponents, it increases operative time and complications of perforation. Early consultation with a surgeon familiar with neonatal care is warranted since treatment is essentially surgical. Early consults facilitate decisions for diagnostic studies, fluid resuscitation, and scheduling the operative procedure.