Infantile Hypertrophic Pyloric Stenosis - Experiences of 77 Cases.

Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants which needs surgical treatment. The aim of this study was to review the management of IHPS in our hospital to compare with other developed centers. This is a prospective analytical study carried out in the Department of Pediatric Surgery, Faridpur Medical College Hospital and Dr. Zahed Children Hospital at Faridpur, during the period of May 2002 to October 2010. Total 77 patients were treated by Ramstedt's pyloromyotomy after proper diagnosis and resuscitation. The male to female ratio was 10:1. Most of the patients presented to us within 40 days of age (90%).Younger one was 15 days and elder one was 69 days. In all cases diagnosis were done on clinical basis. The diagnosis is confirmed by barium meal x-ray in 71 cases and sonogram in 15 cases. Serum electrolytes were not estimated in all patients. There was moderate to severe dehydration in more than 60% cases. 71 cases were operated under general anesthesia and 06 cases were operated with local anesthesia. There was one postoperative death on 4th post-operative day. Oral feeding started after 8 to 10 hours postoperatively in all cases. Mucosal perforation occurred in 1 case and that was recognized and treated conservatively without any ill effect. Superficial wound infection encountered in 3 cases. Early diagnosis, preoperative correction of dehydration and electrolyte imbalance and experiences of surgeons play important role for management of IHPS.

The Clinical Features and Management of IHPS: A Comparison between 1980's and 2000's

PURPOSE: A precise and simple tool for diagnosis and the growing public interest in health caused infantile hypertrophic pyloric stenosis (IHPS) to be diagnosed in good time. The approach to pyloromyotomy as the standard treatment is undergoing changes. We compared 2000's IHPS patients with 1980's to identify the clinical features and management. METHODS: We analyzed, retrospectively, the clinical findings, diagnoses, and treatment of 68 patients with IHPS who underwent pyloromyotomy at Ewha Womans University Medical Center from January 2000 to December 2008 (2000's group), and compared the results with that of 42 patients in the 1980's (1980's group). RESULTS: There were no significant differences in age, gender, birth rank, seasonal distribution, and symptoms between both groups, but the number of patients with metabolic changes and palpable 'olive' was significantly lesser in the 2000's group. Upper gastrointestinal series (UGI) was the most common imaging tool in the 1980's (71.4%) but USG has become the standard diagnostic tool in the 2000's (88.2%). All patients received open pyloromyotomy using traditional incision in the 1980's, and supraumbilical semicircular incision in 36.8% of patients in the 2000's. The average length of hospital stay after operation was significantly shorter in the 2000's group. In the 2000's, the mean preoperative stay at hospital was 4.4+/-4.3 days. Twenty-nine (42.0%) patients did not vomit postoperatively and postoperative vomiting did not delay discharges of any patients. CONCLUSION: There were significant improvements in diagnosis and treatment in the 2000's. We suggest that the surgeon, without the need for a radiologist perform USG for IHPS in order to shorten the preoperative hospital stay.

Clinical Analysis of the Infantile Hypertrophic Pyloric Stenosis

PURPOSE: Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical emergency of infants that exhibits clearly unique characteristic symptoms, but its etiology and pathogenesis are still obscure. The Fredet-Ramstedt pyloromyotomy has gained worldwide acceptance. The advantages of this operation are immediate solution of the problem and few complication. Cosmetically circumumbilical incision or laparoscopic pyloromytomy can be used. METHODS: Forty cases of IHPS admitted to the Chuncheon Sacred Heart Hospital from Jan 1997. to Dec 2002 were reviewed retrospectively. These cases underwent Fredet-Ramstedt's operation. RESULTS: The most prevalent age group was 21~30 days (10 cases: 25%), mean age was 41.4+/-9.9 days, and the males to females ratio was 4.7: 1. Among the 40 cases, 24 (60%) involved the first baby. The mean gestation age was 39.9+/-1.7 weeks and mean birth weight was 3.3+/-0.5 Kg. The mean duration of symptom was 4.1+/-1.6 days. The common symptoms were non-bile stained, projectile vomiting in all cases, an olive-shaped mass in the right upper quadrant abdomen in 21 cases (52.5%), visible peristalsis on epigastrium in 16 cases (40%), and jaundice in 1 case (2.5%). Hypokalemic alkalosis was observed in 3 cases (7.5%). The mean length and thickness of the stenotic canal, as measured in the operation, were 28.8+/-8.5 mm and 4.9+/-0.6 mm, respectively. Postoperative complications were one case each (2.5%) pneumonia, wound seroma, and recurrence. Conclusion: Fredet-Ramstedt's pyloromyotomy for IHPS is an effective operation after the correction of dehydration and electrolyte imbalance.