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RESUMEN La estenosis hipertrófica del píloro es la obstrucción parcial o completa de la luz del píloro, su musculatura se halla tan fuertemente engrosada, que el vaciamiento gástrico se dificulta. Aunque el diagnóstico es básicamente clínico, los estudios imagenológicos son decisivos para confirmar la enfermedad. Se realizó un estudio descriptivo retrospectivo en 119 pacientes con manifestaciones clínicas de estenosis hipertrófica del píloro, cuyo diagnóstico se confirmó mediante estudios de imágenes, en el Hospital Pediátrico Universitario "William Soler" desde el año 2000 al 2015. Las medidas ecográficas fueron la longitud del canal pilórico ≥ 16mm en 95,8%, la pared del músculo pilórico en 88,2% y el diámetro de la oliva pilórica en el 68,1 % de los pacientes. En 90 niños se hizo el diagnóstico con la ecografía de abdomen inicial. A los 29 restantes se les realizó radiografía de esófago, estómago y duodeno bajo visión fluoroscópica, observando en el 100% el signo de la cuerda, en 72,4% dilatación gástrica y en 58,6% retardo en la evacuación del estómago. Con una segunda ecografía de abdomen positiva. Corroborándose en todos el diagnóstico en el acto quirúrgico. La ecografía de abdomen fue un medio diagnóstico de alta positividad y sensibilidad, con la longitud del canal pilórico como principal medida ecográfica y el signo de la cuerda el mayor hallazgo radiológico.
ABSTRACT Hypertrophic stenosis of the pylorus is the partial or complete obstruction of the pylorus lumen, its muscles are so strongly thickened that gastric emptying is difficult. Although the diagnosis is basically clinical, imaging studies are decisive to confirm the disease. A retrospective descriptive study was carried out in 119 patients with clinical manifestations of hypertrophic pyloric stenosis, whose diagnosis was confirmed by imaging studies, at the "William Soler" University Pediatric Hospital from 2000 to 2015. The ultrasound measurements were the length of the pyloric channel ≥ 16mm in 95.8%, the wall of the pyloric muscle in 88.2% and pyloric olive diameter in 68.1% of the patients. In 90 children, the diagnosis was done by initial abdominal sonography. The remaining 29 were done barium upper gastrointestinal studies under fluoroscopic vision, observing the string sign in 100%, gastric dilatation in 72.4% and delayed gastric emptying in 58.6%. With a second positive abdominal sonography. Corroborating the diagnosis in the surgical act. Abdominal sonography was a highly positive and sensitive diagnostic study, with the length of the pyloric canal as the main ultrasound measurement and the string sign the major radiological finding.
RESUMO Estenose de pilão hipertrófico é a obstrução parcial ou completa do lúmen do pilão, sua musculatura é tão fortemente espessada, que o esvaziamento gástrico é difícil. Embora o diagnóstico seja basicamente clínico, os estudos de imagemsão decisivos na confirmação da doença. Um estudo retrospectivo descritivo foi realizado em 119 pacientes com manifestações clínicas de estenose de pilópio hipertrófico, cujo diagnóstico foi confirmado por estudos de imagem, no Hospital Pediátrico da Universidade William Soler de 2000 a 2015.As medidas de ultrassom foram o comprimento do canal pilórico ≥ 16mm em 95,8%, a parede do músculo pilórico em 88,2% e o diâmetro da azeitona pilórica em 68,1% dos pacientes. Em 90 crianças, o diagnóstico foi feito com o ultrassom abdominal inicial. Os 29 restantes foram raio-x do esôfago, estômago e duodeno sobvisão fluoroscópica, observando 100% o sinal da corda, 72,4% de dilatação gástrica e 58,6% de atraso na evacuação do estômago. Com um segundo ultrassom abdominal positivo. Corroborando todo o diagnóstico no ato cirúrgico. O ultrassom do abdômen foi um meio diagnóstico de alta positividade e sensibilidade, com o comprimento do canal pilóico como principal medida de ultrassom e o sinal da corda o maior achado radiológico.
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RESUMEN La estenosis hipertrófica del píloro está caracterizada por una hipertrofia e hiperplasia de las fibras musculares y estrechamiento del canal pilórico, que provoca vómitos no biliosos, dando lugar a una de las causas más comunes de tratamiento quirúrgico en la etapa de recién nacido. Se realizó un estudio descriptivo retrospectivo en 119 pacientes con el diagnóstico de estenosis hipertrófica del píloro en el Hospital Pediátrico Universitario "William Soler" desde el año 2000 al 2015. El 70,6% de los niños tenía entre tres y cinco semanas de nacido y el 83,2% un peso al diagnóstico entre 2500 g a 4500 g. El vómito estuvo presente en todos los pacientes, las alteraciones del peso corporal en 79,8% y los desequilibrios hidroelectrolíticos y acido básico en el 53,8%. El sexo masculino, apariencia racial blanca, ser primogénito y la lactancia artificial o mixta, fueron factores de riesgos prevalentes significativos asociados a la enfermedad (p<0.05). La estenosis hipertrófica del píloro se diagnosticó con mayor frecuencia a la 4ta semana de vida y en niños con un peso entre 3000 a 4500 g. Las variaciones ponderales denotan la importancia del seguimiento de la curva de peso en estos pacientes.
ABSTRACT Hypertrophic pyloric stenosis is characterized by hypertrophy and hyperplasia of the muscle fibers and narrowing of the pyloric canal, which causes non-bilious vomiting, giving rise to one of the most common causes of surgical treatment in the newborn stage. A retrospective descriptive study was carried out in 119 patients with a diagnosis of hypertrophic pyloric stenosis at the "William Soler" University Pediatric Hospital from 2000 to 2015. 70.6% of the children were between three and five weeks old and 83.2% a weight at diagnosis between 2500 g to 4500 g. Vomiting was present in all patients, alterations in body weight in 79.8% and hydroelectrolyte and basic acid imbalances in 53.8%. Male sex, white racial appearance, being first-born, and artificial or mixed breastfeeding were significant prevalent risk factors associated with the disease (p <0.05). Hypertrophic pyloric stenosis was most frequently diagnosed at the 4th week of life and in children weighing between 3000 and 4500 g. The weight variations denote the importance of following the weight curve in these patients.
RESUMO A estenose hipertrófica do piloro é caracterizada por hipertrofia e hiperplasia das fibras musculares e estreitamento do canal pilórico, que causa vômitos não biliosos, sendo uma das causas mais comuns de tratamento cirúrgico na fase neonatal. Um estudo descritivo retrospectivo foi realizado em 119 pacientes com diagnóstico de estenose pilórica hipertrófica no Hospital Pediátrico da Universidade "William Soler" de 2000 a 2015. 70,6% das crianças tinham entre três e cinco semanas de idade e 83,2% com peso ao diagnóstico entre 2500 ga 4500 g. Vômito esteve presente em todos os pacientes, alteração do peso corporal em 79,8% e desequilíbrio hidroeletrolítico e ácido básico em 53,8%. Sexo masculino, raça branca, primogênito e amamentação artificial ou mista foram fatores de risco prevalentes e significativos associados à doença (p <0,05). A estenose hipertrófica do piloro foi diagnosticada com maior frequência na 4ª semana de vida e em crianças com peso entre 3.000 e 4.500 g. As variações de peso denotam a importância de seguir a curva de peso nesses pacientes.
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La estenosis hipertrófica del píloro es una enfermedad que se presenta fundamentalmente en lactantes, ocurre por un estrechamiento del canal pilórico debido a la hipertrofia gradual de la capa muscular de su esfínter, lo que origina un síndrome pilórico. El objetivo de esta publicación es presentar una actualización sobre el tema. La etiología de la enfermedad es desconocida, la tendencia actual es que se trata de una enfermedad que no es congénita y se sugiere un origen multifactorial, donde influyen factores genéticos y ambientales. Su síntoma fundamental son los vómitos no biliosos y el diagnostico se complementa con el ultrasonido abdominal. El tratamiento de elección es quirúrgico y sus resultados generalmente satisfactorios. La aprobación de esta guía por los servicios de cirugía pediátrica del país la convierten en un útil instrumento asistencial y docente(AU)
Hypertrophic Pyloric Stenosis is a disease that occurs mainly in infants, caused by a narrowing of the pyloric channel due to the gradual hypertrophy of the muscle layer of the sphincter, which originates a pyloric syndrome. The aim of this publication is to present an update on the topic. The etiology of the disease is unknown, the current trend is that it is a disease that is not congenital and a multifactorial origin is suggested, where genetic and environmental factors influence. Its main symptom is non-bilious vomiting and diagnosis is supplemented with abdominal ultrasound. The treatment of choice is the surgical one and its results are generally satisfactory. The approval of this guidelines by the country's pediatric surgery services makes it a useful care and teaching tool(AU)
Subject(s)
Humans , Infant , Signs and Symptoms , Pyloric Stenosis, Hypertrophic/surgery , Pyloric Stenosis, Hypertrophic/diagnostic imaging , HypertrophyABSTRACT
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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PURPOSE: We attempted to evaluate the outcomes of a newly inaugurated surgical technique of laparoscopic pyloromyotomy with microscope and stab incision (MS-LP) with right upper quadrant transverse open pyloromyotomy (RT-OP), which were performed in a single institution. METHODS: The outcome variables in terms of total anesthesia time, operative time, postoperative emesis, time to full-enteral feeding, postoperative hospital stay, cosmetic result score, medical cost, and postoperative wound complications were compared between the MS-LP and RT-OP groups. RESULTS: Fifty-one consecutive pyloromyotomy cases were enrolled; MS-LP (n=33) and RT-OP (n=18). There was no difference in age, pyloric thickness, and preoperative electrolyte levels between the two groups. The total anesthesia time and operative time of MS-LP were not significantly longer than that of RT-OP. Time to full-enteral feeding and postoperative hospital stay were shorter in MS-LP (20.0±18.3 vs. 35.3±14.8 hrs. and 2.4±1.3 vs. 3.4±1.2 days; p=0.047 and 0.050, respectively). The cosmetic result score and medical cost were significantly higher in MS-LP (9.1±1.0 vs. 7.3±1.2 in terms of scores and 3,501,950±1,093,147 vs. 2,522,474±68,605 in terms of KRW; p=0.001 and 0.021, respectively). No difference in postoperative wound complications was observed between the two groups. CONCLUSION: Laparoscopic pyloromyotomy with microscope and stab incision may suggest recovery benefits with a shorter time to full-enteral feeding and postoperative hospital stay, as well as better cosmetic results than RT-OP. However, MS-LP may induce higher costs.
Subject(s)
Anesthesia , Length of Stay , Operative Time , Postoperative Nausea and Vomiting , Pyloric Stenosis, Hypertrophic , Wounds and InjuriesABSTRACT
Hypertrophic pyloric stenosis is a relatively common affection of gastrointestinal tract in childhood that results in symptoms, such as projectile vomiting and metabolic disorders that imply a high risk of aspiration during anesthetic induction. In this way, the carrying out of a technique with general anesthesia and intravenous rapid sequence induction, preoxygenation and cricoid pressure are recommended. After the correction of systemic metabolic alkalosis and pH normalization, cerebrospinal fluid can keep a state of metabolic alkalosis. This circumstance, in addition to the residual effect of neuromuscular blocking agents, inhalant anesthetics and opioids could increase the risk of postoperative apnea after a general anesthesia. We present the successful management in 3 neonates in those a pyloromyotomy was carried out because they had presented congenital hypertrophic pyloric stenosis. This procedure was done under general anesthesia with orotracheal intubation and rapid sequence induction. Then, ultrasound-guided paravertebral block was performed as analgesic method without the need for administrating opioids within intraoperative period and keeping an appropriate analgesic level. Local anesthesia has demonstrated to be safe and effective in pediatric practice. We consider the ultrasound-guided paravertebral block with one dose as a possible alternative for other local techniques described, avoiding the use of opioids and neuromuscular blocking agents during general anesthesia, and reducing the risk of central apnea within postoperative period.
A estenose hipertrófica do piloro é uma condição relativamente comum do trato gastrintestinal na infância, que causa um quadro de vômitos em jato e alterações metabólicas que envolvem um alto risco de aspiração durante a indução da anestesia. Assim, recomenda-se uma técnica sob anestesia geral e indução intravenosa de sequência rápida, pré-oxigenação e pressão cricoide. Após a correção da alcalose metabólica sistêmica e normalização do pH, o líquido cerebrospinal pode manter um estado de alcalose metabólica. Isso, juntamente com os efeitos residuais de agentes bloqueadores neuromusculares, anestésicos e opioides, pode aumentar o risco de apneia pós-operatória após anestesia geral. Apresentamos o manejo bem-sucedido em três recém-nascidos que foram submetidos a piloroplastia por apresentar estenose hipertrófica do piloro congênita. O procedimento foi feito sob anestesia geral com intubação orotraqueal e indução de sequência rápida. Em seguida, fez-se um bloqueio paravertebral guiado por ultrassonografia como método analgésico sem a necessidade de administração de opioides durante o período intraoperatório e que mantém o nível analgésico adequado. A anestesia regional é comprovadamente segura e eficaz na prática pediátrica. Consideramos o bloqueio paravertebral guiado por ultrassom com dose única como uma possível opção a outras técnicas regionais descritas, evita o uso de opioides e bloqueadores neuromusculares durante a anestesia geral e reduz o risco de apneia central no pós-operatório.
La estenosis hipertrófica de píloro es una afección relativamente común del tracto gastrointestinal en la infancia, que conlleva un cuadro de vómitos en proyectil y alteraciones metabólicas que implican un elevado riesgo de aspiración durante la inducción anestésica. Así, se recomienda la realización de una técnica con anestesia general e inducción de secuencia rápida intravenosa, preoxigenación y presión cricoidea. Tras la corrección de la alcalosis metabólica sistémica y normalización del pH, el líquido cefalorraquídeo puede mantener un estado de alcalosis metabólica. Esta circunstancia, junto con el efecto residual de los bloqueantes neuromusculares, agentes anestésicos inhalatorios y opioides podrían incrementar el riesgo de apnea postoperatoria tras una anestesia general. Presentamos el manejo exitoso en 3 neonatos a los que se les realizó una piloromiotomía por presentar una estenosis hipertrófica de píloro congénita. El procedimiento se realizó bajo anestesia general con intubación orotraqueal e inducción de secuencia rápida. A continuación se llevó a cabo un bloqueo paravertebral guiado por ecografía como método analgésico sin precisar administración de opioides durante el periodo intraoperatorio y manteniendo un adecuado nivel analgésico. La anestesia regional ha demostrado ser segura y efectiva en la práctica pediátrica. Consideramos el bloqueo paravertebral guiado con ecografía con dosis única como una posible alternativa a otras técnicas regionales descritas, evitando el empleo de opioides y bloqueantes neuromusculares durante la anestesia general y reduciendo el riesgo de apnea central en el periodo postoperatorio.
Subject(s)
Humans , Infant, Newborn , Pyloric Stenosis, Hypertrophic/surgery , Anesthesia, General/methods , Anesthetics, Local/administration & dosage , Nerve Block/methods , Ultrasonography, Interventional/methods , Pyloric Stenosis, Hypertrophic/congenital , Intubation, Intratracheal/methodsABSTRACT
Infantile hypertrophic pyloric stenosis (IHPS) is one of the common surgical abdomen in infancy, characterized by progressive non-bilious vomiting. The etiology is unknown, but it likely develops after birth. The pylorus of the stomach becomes thick and triggers progressive vomiting. Abdominal ultrasonography (US) is widely used as a diagnostic tool. Currently, there is a rare IHPS patient with severe metabolic derangement because of general use of abdominal US and its accuracy. We experienced a natural course of a 62- day-old male infant with IHPS who was suffering from intermittent vomiting, loss of weight but had not been properly treated for 1 month. It is needed to make an effort to diagnose differentially in recurrent vomiting infant and check-up regularly, and also educate parents properly.
Subject(s)
Humans , Infant , Male , Abdomen , Education , Parents , Parturition , Pyloric Stenosis, Hypertrophic , Pylorus , Stomach , Ultrasonography , VomitingABSTRACT
La estenosis hipertrófica infantil representa la condición más común que requiere resolución quirúrgica en la infancia temprana. La función y motilidad del píloro está guiada por distintos sistemas que involucran sistema nervioso entérico, hormonas gastrointestinales y las células intersticiales de Cajal, es así como distintos factores que afecten dichos componentes se ven involucrados en las distintas hipótesis de la fisiopatogenia de la enfermedad. El diagnóstico se basa clásicamente en historia clínica, examen físico y estudios de imágenes. El manejo ha sido clásicamente quirúrgico, mediante la piloromiotomía de Ramstedt, sin embargo se ha planteado manejo farmacológico mediante sulfato de atropina.
Infantile hypertrophic stenosis is the most common condition requiring surgical intervention in early childhood. The function and motility of the pylorus is guided by different systems involving enteric nervous system, gastrointestinal hormones and the interstitial cells of Cajal, is how different factors affecting these components are involved in the different hypotheses of pathogenesis of the disease. The diagnosis is typically based on clinical history, physical examination and imaging studies. The surgical management has been classically by Ramstedt pyloromyotomy, however pharmacological management has been raised by atropine sulfate.
Subject(s)
Humans , Male , Female , Child , Pyloric Stenosis, HypertrophicABSTRACT
PURPOSE: Hypertrophic pyloric stenosis (HPS) is known to be one of the most common cause of surgery for infants and pyloromyotomy was considered to the standard treatment. There has been an ongoing debate about whether laparoscopic pyloromyotomy (LP) or open pyloromyotomy (OP) is the best option for treating HPS. The aim of this study is to evaluate safety and effectiveness of LP by comparing the clinical results of both surgical strategies performed by single surgeon. METHODS: Between January 2000 and December 2013, 60 patients who underwent pyloromyotomy at Asan Medical Center performed by a surgeon were followed: open-supraumbilical incision (n=36) and LP (n=24). The parameters included sex, age and body weight at operation. Clinical outcomes included operation time, time to full feeding, postoperative hospital stay, and postoperative complications. RESULTS: There were no significant differences in characteristics, postoperative hospital stay between the two groups. Time to full feeding was shorter in LP (OP 24.5 hours vs. LP 19.8 hours; p=0.063). In contrast, the mean operation time was longer in LP (OP 37.5 minutes vs. LP 43.5 minutes; p=0.072). Complications such as perforation of mucosal layer (OP 1 vs. LP 0) and wound problems (OP 2 vs. LP 0) were found to be not worse in laparoscopic group as compared with open group. CONCLUSION: There has no difference both laparoscopic and open-supraumbilical incision in terms of postoperative hospital stay, time to full feeds and frequency of complications.
Subject(s)
Humans , Infant , Body Weight , Laparoscopy , Length of Stay , Postoperative Complications , Pyloric Stenosis, Hypertrophic , Wounds and InjuriesABSTRACT
Objective To determine whether pyloric measurements with ultrasound, that muscle thickness and channel of pyloric, correlated with weight and age in patients with hypertrophic pyloric stenosis (HPS). Methods A retrospective analysis was conducted on 111 cases diagnosed with HPS by operation from 2008 to 2012. Pearson correlation and linear regression analyses were used to determine if there were sta?tistically signiifcant associations between these combinations of factors:age and pyloric muscle thickness, weight and pyloric muscle thickness, age and pyloric length, and weight and pyloric length. Results Patients’mean age was 39.1 d (8-92 days). Their mean weight was 4.3 kg (2.2-7.9 kg). Mean pyloric muscle thickness was 4.8 mm (2-4.6 mm), and mean pyloric length was 17.5 mm (12-23.5 mm). Pearson correlation coefifcient analysis showed a signiifcant correlation between age and muscle thickness (r=0.6, P<0.001) as well as weight and muscle thickness (r=0.486, P<0.001). No signiifcant correlation was found be?tween pyloric length and age or weight. Linear regression analysis demonstrated similar results. Conclusions In patients with HPS, pyloric muscle thickness was directly related to age and weight. Smaller and younger infants with suspected diagnosis of HPS should be followed up even though the minimum diagnostic criterion for muscle thickness or length was not found on ultrasound.
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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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PURPOSE: Hypertrophic pyloric stenosis (HPS) is a common condition affecting infants that causes severe projectile non-bilious vomiting in the first few months of life. Although open pyloromyotomy is the standard treatment for HPS, recently, the laparoscopic approach has rapidly been adopted by pediatric surgeons. The aim of this study is to determine the efficacy and safety of laparoscopic pyloromyotomy by comparing the clinical results of laparoscopic and open pyloromyotomy. METHODS: Between January 2007 and September 2012, a cohort of 69 children who underwent pyloromyotomy at Seoul National University Children's Hospital were followed; open pyloromyotomy (OP, n=56) and laparoscopic pyloromyotomy (LP, n=13). A retrospective analysis of patient's characteristics and clinical outcomes in patients with open or laparoscopic pyloromyotomy for HPS was performed. The evaluated characteristics included gestational age, sex, birth weight, age and weight at operation. Clinical outcomes included operation time, length of hospital stay, time to postoperative full feeds without vomiting, number of postoperative vomiting and complications. RESULTS: There were no significant differences in characteristics, length of hospital stay and time to postoperative full feeds without vomiting between the two groups. Incidence of postoperative vomiting in the LP group was significantly lower than that in the OP group (OP: 5.07+/-4.60 vs. LP: 2.00+/-2.16, p=0.035). In contrast, the operation time was longer, following the LP group (OP: 26.30+/-9.95 vs. LP: 44.15+/-19.56, p0.999) and wound problems (OP: 4 vs. LP 1, p>0.999) were found to be similar in both groups. CONCLUSION: Both open and laparoscopic pyloromyotomy are safe procedures for the management of hypertrophic pyloric stenosis. Incidence of vomiting was statistically superior in the laparoscopic group. In addition, postoperative complications were fewer in this group. However, an improvement in the operation time will be needed for the future development of laparoscopic pyloromyotomy.
Subject(s)
Child , Humans , Infant , Birth Weight , Cohort Studies , Gestational Age , Incidence , Laparoscopy , Length of Stay , Postoperative Complications , Postoperative Nausea and Vomiting , Pyloric Stenosis, Hypertrophic , Retrospective Studies , VomitingABSTRACT
Introducción: La estenosis hipertrofia de piloro es una patología frecuente en edades tempranas. Afecta recién nacidos y lactantes pequeños . Algunos factores de riesgo son sexo masculino, grupo sanguíneos O positivo, uso de macrólidos en embarazo. El diagnóstico se realiza con una adecuada historia clínica y exploración física. Se describen síntomas como vómitos persistentes , pérdida de peso, deshidratación. El diagnóstico se confirma mediante ultrasonografía. El tratamiento en su gran mayoría es quirúrgico, siendo el pronóstico satisfactorio. Objetivo: Describir las principales características epidemiológicas , clínicas , laboratorio, diagnóstico y tratamiento y posibles complicaciones de estos pacientes. Materiales y método: Estudio retrospectivo que incluyó todos los pacientes egresados con diagnóstico de estenosis hipertrófica de píloro, desde el periodo 2005 al 30 de junio 2010 atendidos en el Hospital del Niño. Se recogieron datos mediante formulario de informe prediseñado. Resultados: Se incluyeron 53 pacientes con una media de edad de 5.2 semanas. Se encontraron en su mayoría pacientes de sexo masculino. Las principales manifestaciones clínicas fueron vómitos, disminución de peso, deshidratación. El examen diagnóstico de elección fue el ultrasonido. Todos los pacientes fueron manejado de forma quirúrgica . No se reportaron complicaciones en los pacientes. Discusión: Es una de las principales causas de cirugía en niños pequeños. El avance en el conocimiento de las manifestaciones clínicas llevan a un diagnóstico eficaz y temprano. La historia clínica y la exploración física son la herramienta principal en el diagnóstico ayudado con herramientas tecnológicas como la ultrasonografía por su alta sensibilidad, especificidad y bajo costo. El tratamiento quirúrgico es curativo con complicaciones infrecuentes y buen pronóstico a largo plazo.
Introduction: Hypertrophic pyloric stenosis is a common disease at early ages. It affects newborns and infants. Some risk factors are male sex, blood group O positive, macrolide use in pregnancy. The diagnosis is made with appropriate history and physical examination. We describe symptoms such as vomiting, weight loss dehydration. The diagnosis is confirmed by ultrasonography. Treatment is mostly surgical prognosis remains unsatisfactory. Objetive: To describe the main epidemiological , clinical , laboratory, diagnostic, treatment and possible complications in these patients. Materials and methods: Retrospective study included all patients discharged with the diagnosis of hypertrophic pyloric stenosis, from the period 2005 to June 30, 2010 treated at the Hospital del Niño. Data were collected using pre-designed report form. Results: 53 patients with a mean age of 5.2 weeks. Found mostly male patients. The main clinical manifestations were vomiting, weight loss, dehydration. The diagnostic test of choice was the ultrasound. All patients were managed surgically. There were no complications in patients. Discussion: It is a major cause of surgery in young children. The progress of knowledge in understanding the clinical findings lead to effective early diagnosis. The clinical history and physical examination is the main tool n the diagnosis helped with technological tools such as ultrasound for high sensitivity, specificity and low cost. Surgical treatment is curative with rare complications and good long-term prognosis.
ABSTRACT
Gastric duplication is a rare anomaly which account for only 3.8% of all gastrointestinal duplication. Gastric duplications are usually cysticlesion without communication with lumen. Most frequent presentation is an abdominal mass with vomiting, mainly diagnosed within the first year of life. Surgical removal is necessary in all cases, and optimal timing for surgery is the time that diagnosis is made. However, prenatally diagnosed gastric duplication is getting more common, and determining timing for surgery is not easy due to absent or minimal symptoms just after birth. We experienced prenatally diagnosed gastric duplication in a female newborn baby that gastric duplication was suggested in 24th week of gestational age through prenatal ultrasonogram. Surgical removal was done at 3 months after birth, and showed good results. We think that natural history of gastric duplication and prevalent age of surgical disease which is similar to gastric duplication such infantile hypertrophic pyloric stenosis should be considered when timing of surgery on prenatally gastric duplication is decided.
Subject(s)
Female , Humans , Infant, Newborn , Gestational Age , Natural History , Parturition , Pyloric Stenosis, Hypertrophic , VomitingABSTRACT
Infantile hypertrophic pyloric stenosis (IHPS) is common surgical disease in infants having vomiting. This disease is still not fully documented despite of various hypotheses. This article reviews the literature on the etiology, clinical course, diagnosis and management of IHPS including recent opinion.