This chapter describes surgical pyloromyotomy as performed by both open and laparoscopic techniques for hypertrophic pyloric stenosis. The text includes an introduction that outlines the indications, risks, alternatives, essential steps needed, equipment, and variations in technique for the procedure in question. This is followed by a template operative dictation, which provides the reader with an operative report, such as is found in a patient chart or electronic medical record. A description is provided of the following critical concepts for this procedure: complete, safe myotomy.