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PubMed1996

Who should treat pyloric stenosis: the general or specialist pediatric surgeon?

Recent reports suggest that children under 3 years of age are best operated on by a specialist pediatric surgeon. In the United Kingdom, hypertrophic pyloric stenosis traditionally has been treated by adult general surgeons. Should this change? In 1991, a retrospective review of 10 years' experience with pyloric stenosis, managed by general surgeons in a large district general hospital, was published. In 1969, an accredited pediatric surgeon, who largely took over the management of pyloric stenosis, was appointed to the staff. His results with 70 children over a 5-year period (series 2) were reviewed retrospectively and compared with the previously published general surgical series of 170 children (series 1). There was no significant difference in the gender, age, or weight distribution between the two series. There was a marked difference in the rates of wound infection (15.5% in series 1; 2.8% in series 2; P < .05), wound dehiscence (6.7% in series 1; 0% in series 2; P < .05), and breach of the duodenal mucosa (12.8% in series 1; 0% in series 2; P < .01). The lower morbidity rate resulted in a shorter hospital stay, with emotional and financial savings. This supports the recommendation that children with this condition should be managed by a pediatric surgeon.

Child, Preschool↗
PubMed1981

Infantile hypertrophic pyloric stenosis.

A brief review of the development of the surgical management of infantile hypertrophic pyloric stenosis is made. The incidence, investigation, management and complications of cases treated at the Royal Hospital for Sick Children, Glasgow over a period of six decades is reported. The mortality fell from 59 per cent in 1925 to 0 per cent in 1975. Pyloromyotomy in infants with hypertrophic pyloric stenosis is shown to be a very effective treatment for this potentially lethal condition and must rank as one of the most cost-effective forms of treatment in medical practice.

Female↗
PubMed1992

Infantile hypertrophic pyloric stenosis in a Third-World environment.

Sixty-two consecutive patients with hypertrophic pyloric stenosis, presenting over a 6-year period, are reported. The sequelae of late presentation and diagnostic delay are outlined. Clinical diagnosis may be difficult. Barium meal examination has proved a more useful single investigation than ultrasonography, although these methods of investigation are complementary. Management difficulties include severe biochemical derangement, correction of which delays surgery. In black communities pyloric stenosis remains a rare condition and heightened clinical awareness remains the most important means of achieving earlier diagnosis.

Humans↗
PubMed1992

Hemoperfusion with a new anion exchange resin corrects the metabolic alkalosis in pyloric stenosis: an experimental demonstration.

An experimental model of hypertrophic pyloric stenosis was made by suture of the pyloric wall and gastrostomy in 10 rabbits under general anesthesia. Blood sampling indicated severe alkalosis and hypochloremia 3h 30 min after surgery. To correct the derangement, we tested an ion exchange resin (Dowex SAR), coated with a methacrylic hydrogel. A cartridge containing 18 g of this resin was inserted in an extracorporeal circuit. This chloride charged resin achieved uptake of HCO3- ions, and elution of Cl- ions. The electrolytic balance was fully restored after 10 min of treatment.

Alkalosis↗
PubMed1975

[Retrospective study of congenital hypertrophic pyloric stenosis and pylorospasm: Surgical vs. non-surgical treatment (author's transl)].

Congenital hypertrophic pyloric stenosis and pylorospasm have extensively been studied in 705 infants treated in 5 pediatric clinics in Hamburg, W.-Germany, during 1961 to 1970. With this report and its statistical evaluation we are aiming to provide basical information to answer the question still open to discussion: Are we allowed to demand surgical treatment in every single case of spastic hypertrophic pyloric stenosis? The following questions have been investigated: distribution of cases due to grade of severity; frequency of surgical and non-surgical, conservative treatment in these groups of different severity; its rate of success and of fatal outcome; length of clinical treatment and hospitalization; frequency of additional, intercurrent disease in both groups, with and without abdominal surgery; complications during and after surgery; late complications with regard to the way of treatment. From our results we conclude that surgical intervention is indicated in severe cases and in cases of medium severity, together amounting to 60% of all cases. In less severe, about 40%, cases non-surgical, conservative treatment is promising in almost all cases. The most important parameter to single out these less severe cases besides the general status is the roetgenologic finding that delayed emptying of the stomach starts within 15 to 20 min. Important as well is a balanced electrolyte and acid-base metabolism. Once more we advocate individual and subtle decision of paramount surgical intervention, reasoning from the background of this study where the percentage of infants successfully treated by non-surgical, conservative medical ways is very high.

Acid-Base Equilibrium↗
PubMedDate not supplied

Medical treatment with atropine sulfate for hypertrophic pyloric stenosis.

We investigated whether atropine sulfate was an effective, non-surgical method for treating hypertrophic pyloric stenosis (HPS). The study group consisted of 5 patients, all of the patients presented with projectile vomiting. Hypertrophic pyloric stenosis was diagnosed based on abdominal sonographic findings. The age when symptom arose was 30.8 +/- 15.5 (mean +/- SD) days, the age upon admission was 43.2 +/- 9.6 days. The frequency of vomiting was 5.8 +/- 2.3 times per day. After admission, all patients received 10% atropine sulfate 0.01 mg/kg intravenous (i.v.) for 5 minutes q4H (every four hours) before each feeding. Formular milk was started and increased by 10 ml every feeding until full feeding (120 ml/kg/day) was achieved. When vomiting had ceased for a period of one day, i.v. atropine was changed to 0.02 mg/kg oral q4H before each feeding. The patient was hospitalized until full feeding was maintained for more than 2 days. Then oral atropine was tapered by half a dose every 2 weeks. Oral atropine was continued until the thickness of the pyloric muscle had normalized (< 3.5 mm). All five patients were successfully treated with atropine sulfate. The frequency of vomiting was reduced to less than two times per day (1.8 +/- 1.3 days). i.v. atropine was used for 6.4 +/- 3.4 days, and the oral form was used for 30 +/- 9 days. The total number of days of atropine sulfate treatment was 36.4 +/- 9.58 days. Full feeding was achieved at 8 +/- 5.3 days. The hospitalization was 14.6 +/- 6.2 days. The body weight when admitted was 4000 +/- 760.8 gm and the body weight when discharged was 4282 +/- 901 gm. The body weight one month after treatment was 5210 +/- 772.5 gm. The body weight gain one month after atropine treatment was 1262 +/- 441.4 gm. Body weigh range on admission was from <3rd to 25th percentile, and after one month of atropine treatment, the body weight range was from 10th to 75th percentile. Complications included transiently elevated heart rates (180-200 times/min) in two patients and facial flushing after the first dose of IV atropine in one patient. In conclusion, conservative treatment with initially IV atropine in the initial stages instead of oral atropine sulfate is an effective alternative to pyloromyotomy, particularly in infants with major concurrent disease or when parents are unwilling to let their infants undergo surgery. Surgical intervention is not always necessary.

Administration, Oral↗
PubMed1988

Recent results of treatment of infantile hypertrophic pyloric stenosis.

During the five year period December 1980 to November 1985, 106 infants with hypertrophic pyloric stenosis were treated. There were no operative deaths, but two late deaths occurred from associated abnormalities. The combination of preoperative rehydration, skilled anaesthesia, and the use of the Fredet-Ramstedt operation (pyloromyotomy) have virtually eliminated mortality from uncomplicated infantile hypertrophic pyloric stenosis. The most common complications were gastro-oesophageal reflux in 11 (11%), perforation of the duodenal fornix in nine (8%), and wound infection in five (5%); no wound dehisced.

Duodenum↗
PubMedDate not supplied

Primary hypertrophic pyloric stenosis in the adult.

A case is reported of a 55 year old male patient with primary hypertrophic pyloric stenosis who was subjected to distal gastrectomy. Adult hypertrophic pyloric stenosis is an uncommon condition which is usually misdiagnosed as carcinoma of the antrum. It is a benign disease resulting from hypertrophy of the circular fibres of the pyloric canal and is recognizable radiologically by narrowing and elongation of the pyloric canal and endoscopically by appearances resembling those of the cervix. This condition is probably congenital although aetiology has not been established. In the absence of symptoms, no clinical treatment is required. However, surgical intervention is advocated, when stenosis gives rise to symptoms, there is a suspicion of malignancy, or the ulceration due to the disease. Distal gastrectomy with gastroduodenostomy is the treatment of choice.

Diagnostic Errors↗
PubMed1989

[Parietal cell vagotomy and dilatation in duodenal ulcer complicated by pyloric stenosis].

In a follow-up study of 32 patients with duodenal ulcer complicated by pyloric stenosis treated by highly selective vagotomy and dilatation of the stricture, we found an ulcer recurrence rate of 19% and a restenosis rate of 7.6% after a minimum of six years of observation. It is concluded, that dilatation can be used as an alternative to former surgical procedures in the treatment of pyloric stenosis and that highly selective vagotomy is still justified in the treatment of some cases of duodenal ulcer.

Adult↗
PubMed1989

Gastric retention of a swallowed coin after surgical treatment of pyloric stenosis.

In patients with a past history of pyloric stenosis, swallowed foreign bodies may not pass out of the stomach. Not only is this clinically relevant, but it also suggests that, even after apparently successful surgery, pyloric function may not be completely normal. A case history is presented and the literature is reviewed.

Child, Preschool↗
PubMed1978

The role of gastrin in congenital hypertrophic pyloric stenosis.

A study was designed and carried out to determine if the canine model of hypertrophic pyloric stenosis is applicable to other species and to demonstrate the transplacental passage of gastrin. Results of the study show that (1) pentagastrin does not induce hypertrophic pyloric stenosis in the rabbit; (2) human gastrin does not cross the canine placenta, and (3) gastrin has no documented and little inferred role in the etiology of CHPS.

Animals↗
PubMed1986

[Results of Lambling gastric juice analysis in infants with spastic hypertrophic pyloric stenosis (SHPS)].

In 27 infants aged 20 to 65 days with clinically and roentgenologically proved hypertrophic pyloric stenosis gastric juice analyses were performed according to Lambling. Basic acid output and maximal acid output in these infants were significantly increased as compared to healthy infants of the same age group. The higher acid output in the hypertrophic pyloric stenosis group was due to higher volumes and a higher acidity of the gastric juices. Basic acid output and maximal acid output increased following pylorotomy. There is evidence, that hyperacidity in pylorus stenosis of infancy is primarily and not due to the pyloric constriction. There was a distinct correlation between the degree of metabolic alkalosis and diminished acid outputs. The findings support the thesis, that infantile hypertrophic stenosis is originated by an increased parietal cell mass. The increased acid secretion and the enhanced release of secretin and cholecystokinin are supposed to originate the hypertrophy of the pyloric muscle.

Female↗
PubMed1993

The value of ultrasound in the diagnosis of congenital hypertrophic pyloric stenosis.

The charts of 103 children with a clinically and surgically confirmed diagnosis of congenital hypertrophic pyloric stenosis were retrospectively reviewed. We found a significant correlation between sonographic and surgical measurements of the muscular thickness of the pylorus (r = .987, P < .001). In 73.7% (76 cases), the clinical picture of gastric outlet obstruction was present when the thickness of the enlarged pyloric muscle was 3.0 mm or more. In 26.3% (27 cases), the pyloric muscle was less than 3.0 mm wide. For 10 patients in whom the muscle width was less than 2.5 mm by sonography, a barium meal was necessary to confirm the diagnosis. The width of the pyloric muscle is the most important factor in the sonographic diagnosis of pyloric stenosis, and even a width of less than 3.0 mm may be associated with clinically significant obstruction.

Female↗
PubMed1993

Hypertrophic pyloric stenosis in the neonate--diagnostic criteria revisited.

The authors analysed 45 ultrasonography (US) studies of 43 infants with surgically confirmed hypertrophic pyloric stenosis (HPS) to ascertain whether the current US criteria for pyloric stenosis are applicable to all infants, including those 30 days of age and younger. Most articles in the radiologic literature cite a muscle thickness of 4 mm or greater and a pyloric canal length of 17 mm or greater as diagnostic of HPS. However, the results of this study suggest that in infants 30 days of age or younger the muscle thickness considered diagnostic for HPS be 3 mm or greater.

Aged↗
PubMed2003

[Hypertrophic pyloric stenosis in infants: laparoscopic pyloromyotomy].

OBJECTIVE: To evaluate the results of laparoscopic pyloromyotomy in infants with hypertrophic pyloric stenosis (HPS). DESIGN: Retrospective. METHOD: Data from medical records were collected on all children who underwent laparoscopic extramucosal pyloromyotomy for hypertrophic pyloric stenosis in the period from 1 October 1993 to 31 March 2001 in the Wilhelmina Children's Hospital of the Utrecht University Medical Centre, the Netherlands. RESULTS: A total of 133 children were operated: 108 boys (81%) and 25 girls (19%). The mean age on the day of operation was 35.3 days (SD: 15.4). Of these children, 17 (13%) were ex-prematures and 8 (6%) were ex-dysmatures, and 40 (30%) had a positive family history for HPS. The mean operating time was 29 min (SD: 10); per surgeon, the first 5 operations required over 30 minutes on average and the following operations lasted an average of 26 minutes. Postoperatively, 84 patients (63%) no longer vomited. Four children required a second operation. The mean period from operation to discharge was 61.6 hours (SD: 46.0). Complications included: perforations of the mucosa (n = 4; 3%), wound infections (n = 4; 3%) and small incisional hernias (n = 5; 4%). CONCLUSION: Laparoscopic pyloromyotomy is an efficient and safe operative technique for the treatment of infants with HPS.

Female↗