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Congenital hypertrophic pyloric stenosis(CHPS)is a common congenital gastrointestinal malformation in infants and young children.The incidence of CHPS has been reported to be 1 to 10 per 10000 live births and CHPS is more common in boys with a sex ratio of 5:1 in our country.Hypertrophic pylori muscle leads to gastric outlet obstruction which causes frequent vomiting.Serious vomiting affects children's growth and even threats to life.The specific pathogenic factors and mechanism of CHPS are still unclear,and studies suggest that it is possiblely related to the abnormalities of the pylori muscle development,the neural innervation,the nerve cell development and the gastrointestinal hormone level.Recently,researches suggest that both environmental factors and genetic factors play a certain role in the pathogenesis of CHPS.This article reviews the research progress of pathogenic factors and pathogenesis of CHPS.
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Objective To compare the clinical effect between laparotomy and laparoscopic pyloromyotomy in the treatment of congenital hypertrophic pyloric stenosis (CHPS).Methods Sixty-three children with CHPS were selected from March 2010 to July 2016 in the Second People's Hospital of Luohe City.The children were divided into laparoscopic operation group (n =31) and laparotomy group (n =32) according to the treatment methods.The children in the laparoscopic operation group were treated with laparoscopic pyloromyotomy,and the children in the laparotomy group were treated with laparotomy.The operation time,intraoperative blood loss,postoperative recovery feeding time,hospitalization time,complications,intragastric pressure and lower esophageal sphincter pressure (LESP) were compared between the two groups.Results There was no significant difference in operation time between the two groups (t =0.277,P ＞ 0.05).The postoperative hospitalization time and recovery feeding time in the laparoscopic operation group were significantly shorter than those in the laparotomy group (t =14.302,17.935;P ＜0.05),and the intraoperative blood loss in the laparoscopic operation group was significantly less than that in the laparotomy group (t =13.064,P ＜ 0.05).There was no significant difference in the intragastric pressure and LESP between the two groups before operation (t =0.316,0.529;P ＞ 0.05).The intragastric pressure after operation was significantly lower than that before operation in the two groups (t =10.613,9.851;P ＜0.05).There was no significant difference in LESP before and after operation in the two groups (t =2.643,2.772;P ＞ 0.05).There was no significant difference in the intragastric pressure and LESP between the two groups after operation (t =0.237,0.329;P ＞ 0.05).The incidence of postoperative complications in the laparotomy group and laparoscopic operation group was 15.63％ (5/32) and 3.23％ (1/31) respectively,the incidence of complications in laparoscopic operation group was significantly lower than that in laparotomy group (x2 =3.991,P ＜ 0.05).Conclusion laparoscopic pyloromyotomy can effectively relieve pyloric stenosis in the treatment of CHPS,and it has the characteristics of small trauma,quick recovery and less complications.
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Congenital hypertrophic pyloric stenosis(CHPS)is a common gastrointestinal congenital mal-formation in neonate and small infants.Pyloromyotomy is an effective method for treatment of CHPS,including several methods.Traditional open pyloromyotomy for the patient's body injury is serious,such as accident of an-esthesia,postoperative infection,skin scar;laparoscopic pyloromyotomy can cause the pylorus muscle incision uncomplete,invasive operation damage,etc.Endoscopic pyloromyotomy for neonatal has some advantages:a lit-tle injury,no scars,simple operation,less complications,quicker recovery of feeding.Endoscopic mucosal pyloro-myotomy may be a new method of treatment,needing further exploration and research.
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Objective To analyze the hypocaloric nutrition(PN) in perioperative of patients with congenital hypertrophic pyloric stenosis ,and to provide reference basis for its clinical application .Methods 40 patients with congenital hypertrophic pyloric steno-sis were choseen in our hospital .All patients were divided into observation group and control group ,20 cases in each group .After the conventional support treatment ,patients in observation group were gave hypocaloric nutrition of 70 -90 kcal/kg ,patients in control group were gave hypercaloric nutrition of 100-200 kcal/kg .After 5 days ,nitrogen balance ,serum protein and body compo-sition were observed in the two groups .Results The nitrogen discharge was increased after parenteral nutrition ,after 2 days reached to peak ,and then began to decline slightly .Under the condition of the same nitrogen intake ,the nitrogen balance in observa-tion group was 10 .65 g/d ,which was significantly lower than 16 .40 g/d in control group (P0 .05) .After parenteral nutrition ,the total protein ,albumin ,prealbumin ,transferrin in observation group were (58 .22 ± 4 .63)g/L ,(43 .42 ± 3 .53)g/L ,(269 .65 ± 31 .24)g/L , (2 .83 ± 1 .23)g/L ,respectively ,which were higher than that in control group (42 .11 ± 3 .52)g/L ,(35 .57 ± 3 .82)g/L ,(252 .34 ± 27 .03)g/L ,(2 .20 ± 1 .30)g/L ,the differences were statistically significant (P0 .05) .Observation group had greater TBF and F% but decreased LBM versus control group (588 .7 ± 66 .8)g vs . (492 .8 ± 65 .6)g ,(17 .5 ± 1 .9)% vs .(15 .0 ± 1 .8)% ,(2 498 .5 ± 118 .9)g vs .(2 604 .7 ± 125 .4)g .The differences were statistical-ly significant(P<0 .05) .Conclusion Hypocaloric nutrition can meet the metabolic needs of patients with congenital hypertrophic pyloric stenosis .Hypocaloric nutrition play a positive role in improving nutritional status and can improve the postoperative rehabilitation .
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Objective To summarize the related factors and nursing countermeasures of complications after the laparoscopy-assisted surgery for congenital hypertrophic pyloric stenosis.Methods Clinical data about the occurrence of complications and nursing points were retrospectively analyzed in 106 cases of neonates and infants.Results Surgical complications occurred in 16 cases,including mucosal perforation in 2 cases,abdominal cavity hemorrhage in 1 case,puncture hole infection in 1 case,repeated postoperative vomiting caused by incomplete pyloric separation in 1 case,postoperative hypercapnia in 2 cases,subcutaneous emphysema in 1 case,8 cases of postoperative hypothermia.No operative deaths.No poking holes hernia and abdominal organ injury.By careful observation and nursing,all cases got rid of postoperative complucations.Within postoperative 3～7 days,they were recovered and discharged,no nursing complications occurred.Conclusions Early discovery of complications and timely nursing intervention are important guarantee for patients to pass through laparoscopic surgery smoothly and obtain swift recovery.
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Objective To evaluate the efficacy and safety of laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) for the treatment of congenital hypertrophic pyloric stenosis(CHPS),and to provide a basis for reasonable treatment programme for clinic.Methods Randomized control trials (RCTs) about LP and OP for the treatment of CHPS were searched using Cochrane library,PubMed,Embase,Cumulative Index To Nursing And Allied Health Literature (CINAHL),Web of Science,Chinese biomedical literature database and China National Knowledge Internet database.Study selection and Meta analysis were conducted according to the Cochrane Handbook for systematic reviews.Extracted data from the selected studies were reviewed by the reviewers and analyzed using RevMan 5.1 software.Results Five RCTs with a total of 552 patients fulfilled the inclusion criteria and were analyzed in this review.Meta analysis showed that there was no statistically significant differences in incidence of postoperative complications between LP and OP (OR =2.59,95 ％ CI:0.90-7.47).Compared with OP,the postoperative recovery eating time and postoperative hospital stay in patient with LP were significantly reduced (MD =-3.63,95％ CI:-5.19--2.06) ;MD =-12.62,95 ％ CI:-16.13--9.11).Conclusions LP result in earlier feeding,shorter hospital stay,less trauma with superior cosmetic outcome and earlier recovery of the patient than the OP.But the postoperative complication between the two surgeries still remains the topic of concern.
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Objective To investigate the clinical characteristics and management of congenital hypertrophic pyloric stenosis (CHPS) associated with intestinal malrotation (IM) in infants.Methods The clinical data of 6 cases with CHPS and IM admitted in our hospital from Jan 2003 to Dec 2009 were reviewed,including clinical presentation,symptoms and information of imageology.Results Through barium meal examination and sonography,4 cases were diagnosed CHPS and IM,pyloromyotomy and Ladd's procedure were performed;two cases were diagnosed CHPS,only pyloromyotomy was done,secondary operation was performed for recrudescence of vomiting.All the cases were followed up for 1 to 3 years with good prognosis.Conclusion The etiology of CHPS with IM isn't clear.The diagnosis of IM may be delayed because the symptoms of IM can be masked by that of CHPS.It is helpful for diagnosis of this disease to have barium meal and sonography examination.Good prognosis will be achieved if prompt preoperative diagnosis and operation can be done.
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Objective To explore the feasibility of tw o- port laparoscopy in the treatment of congenital hypertrophic pyloric stenosis. Methods A total of 21 infants with confirmatively diagnosed con genital hypertrophic pyloric stenosis were given a two-port laparoscopic pylorom yotomy. The procedure was performed using two trocars: a 5 mm trocar at the lowe r border of the umbilical ring was placed for the insertion of camera, and a 3 m m trocar was introduced below the costal margin at the midclavicular line to pas s the hook electrode and curved forceps. Results No conversion s to open surgery were required. The operation time was 23~65 min (mean, 31.3 mi n). The patients were discharged from hospital at 4~6 postoperative days. No com plications occurred. Follow-up for 2~7 months (mean, 3.2 months) showed a norma l development in all the 21 patients. Conclusions Two-port lap aroscopic treameat for congenital hypertrophic pyloric stenosis in infants is ef fective.
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Congenital hypertrophic pyloric stenosis although rare in native Filipino infants does occur. The recognition of the condition depends upon the awareness of this fact. The different manifestations, both clinical and radiologic are often suggestive of the diagnosis. (Summary)
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We had a 2 month, 5.8 kg male infant for a surgery of perianal fistula. He had no considerable past or family history or laboratory data except mild jaundice and abnormal liver function tests. He was intubated after intravenous injection of ketamine and vecuronium. Anesthesia was maintained with isoflurane-N2O and O2. The operation was over within just 10 minutes without any specific event. We found abdominal distension, then suctioned out about 100 ml of milkish, bloody, gastric juice. In recovery room, the patient was cyanotic and a hazziness of the whole lung field was found in the chest X-ray. Acute respiratory failure (ARF) developed and we suspected aspiration. The next day he was diagnosed with congenital hypertrophic pyloric stenosis (CHPS) in sonographic examination. His ARF improved and he recieved pyloromyotomy 2 weeks later. CHPS is a common gasrointestinal disorder requiring operation in the infant stage. We report the ARF of an infant with asymptomatic unrecognized CHPS for anal fistulectomy. The incidence and sonographic features of CHPS and problems associated with anesthetic concerns are discussed.
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Humans , Infant , Male , Anesthesia , Anesthesia, General , Fistula , Gastric Juice , Incidence , Injections, Intravenous , Jaundice , Ketamine , Liver Function Tests , Lung , Pyloric Stenosis, Hypertrophic , Recovery Room , Respiratory Insufficiency , Suction , Thorax , Ultrasonography , Vecuronium BromideABSTRACT
BACKGROUND/AIMS: In 1977, Teele and Smith reported their positive experience using an ultrasonographic in the evaluation of Congenital Hypertrophic Pyloric Stenosis (CHPS). Since that time, ultrasonography has been advocated by some as the diagnostic procedure of choice, although a number of false-negative cases have been encountered at any rate, in 1994, Becker reported that an endoscopy was far more accurate than an ultrasonography, the diagnosis being made in 97% and 81% of the cases. Therefore, we performed a prospective study to evaluate the diagnostic value of an upper gastrointestinal endoscopy in CHPS patients. METHODS: We reviewed the clinical records of 12 pediatric patients experiencing vomiting, who had visited Pusan National University Hospital from January 1993 to March 1997. We performed on upper gastrointestinal endoscopy and abdominal ultrasonography simultaneously in order to evaluate the diagnostic value of an upper gastrointestinal endoscopy in CHPS patients. RESULTS: The male to female ratio was 11: 1. In 7 of 12 patients, 58%, vomited within 4 weeks after birth. Diagnostic sensitivity by abdominal ultrasonography was about 75%, and by upper GI endoscopy, almost 100%. Associated lesions were discovered in 5 cases, 3 esophagitis and 2 gastritis in the upper GI endoscopy. CONCLUSIONS: The upper GI endoscopy was more accurate in the diagnosis of CHPS than the ultrasonography, and was more effective in the diagnosis of associated lesions.
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Female , Humans , Male , Diagnosis , Endoscopy , Endoscopy, Gastrointestinal , Esophagitis , Gastritis , Parturition , Prospective Studies , Pyloric Stenosis, Hypertrophic , Ultrasonography , VomitingABSTRACT
Congenital hypertrophic pyloric stenosis is one of the most common gasttointestinal abnonnalities occurring in the first six months of life. Although the primary therapy for pyloric stenosis is surgical, it is essential to realize that pyloric stenosis is medical and not a surgical emergency. Preoperative preparation is the primary factor contributing to the low perioperative complication rates and the necessity to recognize fluid and electrolyte imbalance is the key to successful anesthetic management. The anesthetic records of 156 infants with congenital hypertrophic pyloric stenosis were reviewed. Seventy-six per cent of the infants were male(i.e., 3:1 male to female ratio). Surgical correction was undertaken between age of 2 and 3 weeks, and the average weight of the infants at the time of surgery was 3.74+/-0.68 kg. All the infants received general anesthesia for the surgical procedure and assist respiration through the laryngeal mask airway was applied increasingly from 1992. There were no perioperative deaths.
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Female , Humans , Infant , Male , Anesthesia , Anesthesia, General , Emergencies , Laryngeal Masks , Pyloric Stenosis , Pyloric Stenosis, Hypertrophic , RespirationABSTRACT
Congenital hypertrophic pyloric stenosis is the most common intra-abdominal disease required surgery during the first few months of life. The expression of pyloric stenosis is dependent upon the genetic influence of ancestors affected with the disease, as well as unknown environmental influences in the postnatal period. Pyloric stenosis has been reported in multiple sibs in a family, which suggests the genetic influence on the expression of this disease. Until now, the genetic influence is thought a sex-modified polygenic or multifactorial background which facilitates the expression of a common dominant gene. We experienced a case of congenital hypertrophic pyloric stenosis in a two siblings. The siblings suffered projectile vomiting for 2~4 days at 16 days old of age and 15 days old of age. After we confirmed the diagnosis by upper gastrointestinal series and abdominal sonogram, the Fredet-Ramstedt pyloromyotomy was done successfully. This case suggests the genetic influence on the expression of this disease.
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Humans , Diagnosis , Genes, Dominant , Pyloric Stenosis , Pyloric Stenosis, Hypertrophic , Siblings , VomitingABSTRACT
Congenital hypertrophic pyloric stenosis is characterized by projectile vomiting and pyloric thickening, and must be differentiated with gastroesophageal reflux. Gastroesophageal reflux may defined as relaxation of lower esophageal sphincter causing return of stomach content into eophagus, and frequently associated with hiatal hernia. The authors presented a case, having congenital hypertrophic pyloric stencsis and gastroesophageal reflux simultaneously which must be differentiated each other, in 28 days old newborn male with chief problem of severe projectile vomiting. A brief review of literatures was made on this subject.