Infantile hypertrophic pyloric stenosis: surgical or medical treatment?

Surgical treatment is the gold standard method for treatment of infantile pyloric stenosis. Surgery, however, is not without risks. Medical treatment with atropine was introduced long time ago and seems to be an attractive alternative to surgery. To treat infantile pyloric stenosis medically or surgically is still a controversial area. To test whether medical treatment is as effective as surgery in treatment of infantile pyloric stenosis and to determine which infant is suitable for either modality. 28 infants with infantile pyloric stenosis were included in this study. In all infants the diagnosis was confirmed by an abdominal ultrasound and gastrographin study. Medical treatment consisted of intravenous atropine 0.01 mg/kg /dose every 4 hours followed by oral atropine 0.02 mg/kg/dose every 6 hours. Surgical treatment consisted of standard Ramstdt's pyloromyotomy under general anesthesia. 14 infants were treated medically and 14 infants were treated surgically. Medical treatment was successful in 8 infants [66%] whereas surgical treatment was successful in all cases [p <0.002]. Mean hospital stay was 10 +/- 2 days in medically treated infants and it was 3 +/- 1 days in surgically treated infants [P<0.0001]. In our Hospital, surgical treatment is superior to medical treatment in cases of infantile pyloric stenosis. However the encouraging success rate of medical treatment may justify trying it in infants waiting for surgery or in infants in whom surgery is contraindicated