Pyloric Stenosis Research Articles

Our approach to early and late complıcatıons of laparoscopıc sleeve gastrectomy patients

Aim: Laparoscopic Sleeve Gastrectomy (LSG) is used as an effective surgical method in the treatment of morbid obesity. In our study, we investigated the early and late complications and treatment methods of our patients who underwent LSG.Material and method: 390 patients between the ages of 18-70 who were operated between January 2016 and December 2020 were included in the study. Patient records were retrospectively scanned electronically and the results were recorded.Results: Laparoscopic sleeve gastrectomy surgery was performed on 390 morbidly obese patients. Of the patients, 310 (78.1%) were female, 80 (21.9%) were male, with a mean age of 42.1 years (22-65) and 42.9 years (24-70) patients. Complications were observed in 22 (5.64%) patients with LSG. Ten (2.56%) of the patients developed complications in the early period, 9 (2.33%) developed complications in the late period, and 3 (0.75%) of them developed both early and late complications.Early complications; Postoperative early anastomosis leakage in 4 (1%) patients, atelectasis in 2 (0.5%) patients, bleeding in 1 (0.25%) patient, dehydration in 1 (0.25%) patient, intra-abdominal collection in 1 (0.25%) patient, pleurosis in 1 (0.25%) patient was detected. Stent was applied to the patients with leakage, and the patient with bleeding was operated. Other patients received medical treatment.Late complications; Minimal stenosis causing reflux in the incisura angularis was found in 5 (1.25%) patients, and trocar port hernia was found in 4 (1%) patients.Early and late complication; Late complications were also observed in 3 (0.75%) patients who underwent stenting due to early leakage. Late pyloric stenosis was detected in 1 (0.25%) of these patients, gastric ulcers in 1 (0.25%) and esophagocardial stenosis in 1 (0.25%) patient. Patients with trocar port hernia and patients with severe symptomatic incisura angularis stenosis were treated surgically, while other patients were treated medically. No mortality was observed.Conclusion: Laparoscopic sleeve gastrectomy, which is an effective method in the treatment of morbid obesity, can have serious early and late complications. For this reason, we believe that it will be safer to operate them in centers where necessary intensive care conditions and endoscopic interventions such as stenting can be performed quickly and reliably.

Azithromycin for Eradication of Ureaplasma and Prevention of Bronchopulmonary Dysplasia in Preterm Neonates in the Neonatal Intensive Care Unit.

Azithromycin has been explored as a treatment option for eradication of Ureaplasma and prevention of bronchopulmonary dysplasia (BPD) in preterm neonates. However, there is debate about the need for eradication of Ureaplasma and whether azithromycin is safe and efficacious for this indication. This literature review provides an overview of the evidence for use of azithromycin for eradication of Ureaplasma and prevention of BPD, including dosing and duration of azithromycin used in these studies. The literature search included articles published in the English language in Medline and PubMed from 1946 to January 2022. Relevant citations within identified articles were also reviewed. A total of 9 studies representing 388 neonates were included. The percentage of neonates that tested positive for Ureaplasma in these studies ranged from 18.6% to 57.1%. Azithromycin was initiated at <3 days of life in 8 studies (88.9%). Dosing was variable and ranged from 5 to 20 mg/kg/dose administered once daily, and the duration of treatment ranged from 1 to 35 days. Most studies used intravenous azithromycin. Overall, azithromycin was more efficacious than placebo at Ureaplasma eradication; however, most of these studies did not find a difference in the incidence of BPD between patients receiving azithromycin versus placebo. No adverse effects, specifically pyloric stenosis or QT interval prolongation, were noted in these studies.

ICRI White Paper: An Update on Role of Conventional Radiography in Imaging of Pediatric Gastrointestinal Tract.

Plain abdominal radiographs and gastrointestinal contrast studies remain the first line of investigation for the evaluation of several conditions due to their easy availability and ease of use in pediatric patients. A systematic approach to evaluating the plain radiograph for pediatric abdomen can lead the radiologist to a relevant differential diagnosis in most cases. In other cases, it leads the radiologist to the next line of investigation. The plain radiograph of the abdomen is requested for several conditions ranging from abdominal pain, vomiting, failure to pass meconium, abdominal distension, perforation, mass or for suspected obstruction. The radiation dose involved in abdominal radiography, although significant, the diagnostic information provided outweighs the risk. Dose reduction techniques should be employed to reduce the radiation dose to infants and children. Spectrum of atresias and stenosis from the esophagus up to the rectum, Hirschsprung disease, small left colon syndrome, and anorectal malformations can be identified with a detailed and systematic contrast study. They act as an adjunct in the diagnosis of conditions such as intussusception and hypertrophic pyloric stenosis. Inflammatory conditions such as acute appendicitis, necrotizing enterocolitis, and acute conditions such as pneumoperitoneum are also well appreciated on plain abdominal radiographs.

Ультрасонографія у діагностиці гіпертрофічного пілоростенозу в дітей: переваги та «підводні камені»

Hypertrophic pyloric stenosis (HPS) in newborns is the one of the most frequent causes of vomiting that required surgery. During long period of time, X-ray was the main method for the confirming diagnosis of HPS, however after first reports about possibilities of ultrasonography (US), this method was widely applied in clinical practice. Purpose - to summarize own experience of US applying for the diagnostic of HPS; determining advantages and disadvantages of this method of examination. Materials and methods. This study based on the US results of 93 patients with HPS and 27 children with pylorospasm that were observed and treated in Lviv regional children’s clinical hospital for 2009-2020 years. By US measured the thickness of pyloric muscle, length, front-posterior (transverse) size, and diameter of orifice of pyloric canal. Results of the study were evaluated by the statistical program StatPlus: mac, AnalystSoft Inc. (version v8). Results. The thickness of pyloric muscle and pyloric canal length are the major criteria of confirming/excluding HPS diagnosis. By the measurement of pyloric muscle thickness, it is necessary to remember that tangential position of transducer and muscles’ contraction can cause pseudo-thickening. According to the results of the study, the thickness of pyloric muscle in case of HPS was 6.4±0.3 mm (a range - 3-10 mm) and was no correlation nor with duration of illness (p=0.364) nor with age of child (p=0.534). In pylorospasm, which clinically can simulate HPS, the thickness of the pyloric muscle was 3.02±0.1 mm, what is significantly less compared to infants with HPS (Student’s t-test - 1.983; p=0.0000). Pyloric canal length in case of HPS was 22.9±0.6 mm (a range - 16-32 mm), what also was significantly differed than in case of pylorospasm - 15.8±0.5 mm (Student’s t-test - 1.998; p=0.0000). This was only indicator that clear correlated with child’s age (p=0.004) and duration of illness (p=0.006). Diameter of pyloric canal orifice and front-posterior size differed from indices in children with pylorospasm also. According to the results of ROC analysis, the best markers for the confirming diagnosis of HPS was thickness of pyloric muscle, its length, and front-posterior size, while the diameter of pyloric canal orifice shows the moderate prognostic significance. Conclusions. Ultrasonographic examination makes it possible to establish the diagnosis of HPS in newborns with a high degree of reliability. A doctor, who performs US in a child with suspected pylorostenosis, should be guided by the size of the unchanged pyloric canal and in case of its hypertrophy remember the «pitfalls» in the examination and know the ways to overcome them. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Exploring GI Diseases Across the Lifespan.

Exploring GI Diseases Across the Lifespan.

Endoscopic Balloon Dilation of a Pyloric Stricture Caused by Sarcina Ventriculi Infection

Endoscopic Balloon Dilation of a Pyloric Stricture Caused by Sarcina Ventriculi Infection

Diagnostic Accuracy of Acid-Base Status in Infants with Hypertrophic Pyloric Stenosis.

Hypertrophic pyloric stenosis is a condition in newborns in which the hypertrophic pyloric muscle causes gastric obstructive symptoms of progressive vomiting leading to hypochloremic hypokalemic metabolic alkalosis. The main aim of the research was to assess whether, based on the acid-base status, we can distinguish newborns who vomit due to pylorostenosis, compared with newborns who vomit for other unspecific reasons. The electronic records of patients in the hospital information system treated under the diagnosis Q40.0 (Congenital hypertrophic pyloric stenosis) (n = 69/included in the study = 53) in the period from 1 January 2014 to 1 January 2022 were reviewed retrospectively. For the purposes of the control group, the electronic records of patients treated in the emergency department with a diagnosis of R11.0 (Nausea and vomiting) (n = 53) without an established cause were randomly reviewed. In addition to the main aim, other research outcomes were to determine differences between groups in the following variables: duration of symptoms, family history, birth (preterm, term, post-term), birth weight, weight during examination, difference between birth weight and weight during an examination, type of vomiting, the thickness of the muscle wall and its length, and to calculate whether there is a correlation between the thickness and length of the pylorus muscle and the duration of vomiting in relation to variables from acid-base status. In relation to the variables of interest between the groups, statistically significant differences were observed in the duration of symptoms (Mdn 4 vs. 2 days, p = 0.002), weight at examination (Mean 3880 vs. 4439 g, p = 0.001), difference in weight between birth and examination (Mean 374 vs. 1010 g, p &lt; 0.0001), and type of vomiting (explosive 45 vs. 22, p = 0.023). In the acid-base status between the groups, a statistically significant difference was recorded for pH (Mdn 7.457 vs. 7.422, p &lt; 0.0001), bicarbonate (Mdn 25 vs. 23 mmol/L, p = 0.000), total carbon dioxide (Mdn 25 vs. 24 mmol/L, p = 0.011), base excess (Mdn 0.8 vs. -1.3 mmol/L, p = 0.000), potassium (Mdn 5 vs. 5.3 mmol/L, p = 0.006), ionized calcium (Mdn 1.28 vs. 1.31 mmol/L, p = 0.011), and glucose (Mdn 4.5 vs. 4.9 mmol/L, p = 0.007). Regardless of the group, the correlations between the duration of vomiting (r = 0.316, p = 0.021 vs. r = 0.148, p = 0.290) and the thickness (r = 0.190, p = 0.172) and length (r = 0.142, p = 0.311) of the pylorus muscle in relation to pH did not exist or were weak. In a world where radiological methods are not equally available everywhere, with promising acid-base indicators, prospective multicenter studies and meta-analyses must be pursued in the future in order not to miss the possible much greater diagnostic potential of acid-base status.

Application of visual placement of a nasojejunal indwelling feeding tube in intensive care unit patients receiving mechanical ventilation.

Compared with nasogastric nutrition, nasojejunal nutrition may prevent some complications of critically ill patients by maintaining better nutritional status, and blind placement of nasojejunal dwelling feeding tubes is widely used. However, the visual placement seems to be safer and more effective than the blind placement, and is still seldom reported. We tried to develop visual placement of a nasojejunal feeding tube in intensive care unit patients. A total of 122 patients receiving mechanical ventilation were admitted to the Department of Critical Care Medicine of the Fifth Affiliated Hospital of Wenzhou Medical University and received the placement of nasojejunal feeding tubes. These patients were randomly and evenly assigned into two groups, one group receiving visual placement of nasojejunal dwelling feeding tubes and another group receiving blind placement. Actual tube placement was confirmed by X-ray. The primary outcome included the success rates of first placement of feeding tubes. The secondary outcome included the time of tube placement, complications, the total cost, heart rates and respiratory rates. The primary outcome showed that the success rates of first placement were 96.70% (59 cases/61 cases) in the visual placement group, and two cases failed due to pyloric stenosis and gastroparesis. The success rates were 83.6% (51 cases/61 cases) in the blind placement group and 10 cases failed due to either wrong placement or retrograde tube migration. The success rates in the visual placement group were higher than that in the blind placement group (P = 0.015). The secondary outcome showed that the time of tube placement in the visual placement group was shorter than that in the blind placement group (P < 0.0001). The cost of tube placement in the visual placement group was higher than that in the blind placement group (P < 0.0001). The statistical differences in complications, heart and respiratory rates were insignificant between the two groups (P > 0.05). Compared with the blind placement, the visual placement shortened the time of nasojejunal tube placement and increased success rates of first placement. The visual placement was more efficient, easy to operate, safe, and has potential clinical applications.

Safety and Efficacy of Fully Covered Self-Expandable Metal Stents for Benign Upper Gastrointestinal Strictures Beyond the Esophagus.

Background Stents utilized for pyloric, duodenal, or anastomotic malignant strictures are generally uncovered and are not retrievable. Taewoong Medical created a through-the-scope stent that is fully covered, retrievable, and can be placed beyond the esophagus for benign gastroduodenal strictures as an alternative to surgical approaches. The aim of this paper is to examine the safety and efficacy of short-term, fully covered, self-expanding metal stents (FC-SEMS) in refractory benign strictures of the pylorus, duodenum, and gastrojejunal anastomosis. Methodology This multicenter case series was conducted at four hospitals from January 2018 through December 2020. Patients presenting with benign strictures of the pylorus, duodenum, or gastrojejunal anastomosis were entered into the study. A therapeutic channel scope was utilized to place FC-SEMSto open strictures. The stents were removed a few weeks later. A four-point gastric outlet obstruction scoring system (GOOSS) was used to record improvement. Results Statistically significant improvement in GOOSS was found between the pre-procedure and the four-week follow-up. Conclusions Fully covered, retrievable metal stents appear safe and effective in the management of refractory benign pyloric, duodenal, and anastomotic strictures. This may provide a less invasive option in the management of these strictures compared to surgery.

ODP378 Biliary Sludge in a Neonate with Congenital Hypothyroidism

Abstract Background Most cases of congenital hypothyroidism are asymptomatic. When signs are evident, they are nonspecific. Characteristic clinical findings, including prolonged jaundice are seen in less than 5% of affected neonates. Clinical Case Female newborn, full term, appropriate weight for gestational age, five days old, Kramer zone 3 jaundice. The laboratory ruled out hemolysis, blood group incompatibility and TORCH infections. Hepatobiliary ultrasound showed biliary sludge. The screening for congenital hypothyroidism reported a TSH value of 38 mlU/L; the free T4 value was analyzed and was low. With the diagnosis of congenital hypothyroidism, levothyroxine therapy was started. The biliary sludge disappeared two weeks after initiation of hormone therapy. Conclusion It is important to exclude other causes of biliary sludge formation, such as sepsis, parenteral nutrition, hemolytic disease, metabolic diseases, some drugs and pyloric stenosis. Congenital hypothyroidism may be associated with biliary sludge formation; thyroid hormones have an inhibitory effect on the contractility of the sphincter of Oddi. Presentation: No date and time listed

Recurrent Infantile Hypertrophic Pyloric Stenosis in the Emergency Department: A Case Report.

Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of infant vomiting. Emergency department (ED) diagnosis is usually made by pyloric ultrasound and treated by pyloromyotomy. An eight-week-old boy with a history of IHPS about six weeks status post pyloromyotomy presented to the ED with vomiting and failure to thrive, and a critically narrowed pylorus was identified by ultrasound. An upper gastrointestinal series confirmed recurrent pyloric stenosis, necessitating another pyloromyotomy. Prolonged vomiting after pyloromyotomy should be concerning for recurrent IHPS. Upper gastrointestinal series should augment ultrasound to diagnose recurrent IHPS and determine whether a second pyloromyotomy is warranted.

Identifying syndromes in studies of structural birth defects: Guidance on classification and evaluation of potential impact.

Structural birth defects that occur in infants with syndromes may be etiologically distinct from those that occur in infants in whom there is not a recognized pattern of malformations; however, population-based registries often lack the resources to classify syndromic status via case reviews. We developed criteria to systematically identify infants with suspected syndromes, grouped by syndrome type and level of effort required for syndrome classification (e.g., text search). We applied this algorithm to the Texas Birth Defects Registry (TBDR) to describe the proportion of infants with syndromes delivered during 1999-2014. We also developed a bias analysis tool to estimate the potential percent bias resulting from including infants with syndromes in studies of risk factors. Among 207,880 cases with birth defects in the TBDR, 15% had suspected syndromes and 85% were assumed to be nonsyndromic, with a range across defect types from 28.5% (atrioventricular septal defects) to 98.9% (pyloric stenosis). Across hypothetical scenarios varying expected parameters (e.g., nonsyndromic proportion), the inclusion of syndromic cases in analyses resulted in up to 50.0% bias in prevalence ratios. In summary, we present a framework for identifying infants with syndromic conditions; implementation might harmonize syndromic classification across registries and reduce bias in association estimates.

Coexistence of Hypertrophic Pyloric Stenosis and Long-gap Isolated Esophageal Atresia: A Case Report and Review of the Literature

Coexistence of Hypertrophic Pyloric Stenosis and Long-gap Isolated Esophageal Atresia: A Case Report and Review of the Literature

S1106 Analysis of Reported Adverse Events Related to Over the Scope Clips: A MAUDE Database Analysis

Introduction: Over-the-scope clips (OTSC) have been increasingly used in the management of bleeding, perforations, fistulae, and anastomotic leaks in the gastrointestinal tract. However, since their Food and Drug Administration (FDA) approval in 2010, data on the adverse events of OTSC systems has been lacking. Our study aims to report and analyze adverse events and device failures associated with OTSC systems using the FDA’s Manufacturer and User Facility Device Experience (MAUDE) database. Methods: We analyzed the post-marketing surveillance data from the FDA MAUDE database of the two OTSC systems available in the United States: The Padlock clip system and the Ovesco OTSC from April 2017 through May 2022. Results: Thirty-six medical device reporting claims were found from May 2017 through May 2022. Adverse events were classified as device-related problems and patient-related adverse events. Thirty-six device-related problems were reported, along with sixteen device-related adverse events (Table). Most device-related problems were reported in the Padlock defect closure system (n=23), followed by the Padlock pro clip system (n=8) and Ovesco OTSC clip system (n=5). The most common device-related problem was related to the failure of deployment of OTSC (n=14), followed by material protrusion or extrusion (n=6). The most common patient adverse events were perforation (n=4), bleeding (n=3), esophageal laceration (n=3) and luminal stenosis (n=2). Three out of four perforations were in the Padlock pro select closure system. All four patients required surgical management of the perforation. No deaths related to the use of OTSC were reported. Conclusion: Using the data from a publicly available database, the overall adverse events from OTSC systems remain low. Failure of OTSC deployment and perforation were the most common device-related problem and patient-related adverse events, respectively. The identification of common adverse events has the potential to optimize device design and patient outcomes. It is important for endoscopists to be mindful of these potential adverse events when using over-the-scope clips. Table 1. - Device-related problems and adverse events Device-related problems Number Failure of OTSC deployment 14 Other 8 Separation problems 3 Detachment of the device 2 Protrusion or extrusion of over the scope clip system 6 Defective device component 2 Failure of positioning of the device 1 Total 36 Patient related- adverse events Number Gastro-gastric fistula 1 Perforation 4 Local trauma 1 Pain 1 Bleeding 3 Pyloric stenosis 1 Colonic stenosis 1 Esophageal laceration 3 Ulcer 1 Total 16

S2513 Not All That Appears Like Oral Thrush Is Candidiasis: A Case of Oral Actinomycosis

Introduction: Oral thrush is one of the most common infections that affect the oral cavity. The oral candidiasis lesions classically present as whitish confluent plaques on oral cavity examination of tongue, palate, and buccal mucosa. Oral thrush has long been associated with overgrowth of Candida albicans in the mouth in dialysis dependent patients, diabetics, immunocompromised, and who are on corticosteroid therapy. In this abstract we present a case of oral actinomycosis mimicking oral thrush upon presentation. Case Description/Methods: 51-year-old female a history of squamous cell esophageal cancer status post distal esophagectomy and gastric pull through operation 5 years ago. She with a presented with a chief complaint of odynophagia and recurrent episodes of dysphagia for solid foods that has been worsening since past few weeks. About 6 months ago the patient had an upper endoscopy, which was significant for acute gastritis and pyloric stenosis, which was dilated. No obvious thrush was identified during that visit. Patient was not on any immunosuppressive medication. A repeat upper endoscopy was performed at this visit which was revealing of thrush in the oropharyngeal area and chronic gastritis. Tongue brushings were obtained for cytopathological analysis, which were suggestive of actinomyces infection. The patient was started on amoxicillin therapy for 2 weeks, which resulted in resolution of thrush as well as her clinical symptoms. Other treatment alternatives for actinomycosis include doxycycline, clindamycin, ceftriaxone, and imipenem (Figure). Discussion: Actinomyces is a rare bacterium often found in the head and neck region. They are partially acid-fast, filamentous gram-positive microorganisms. They were originally classified with fungi organisms as they possess hyphae. Actinomyces is considered to cause chronic suppurative infection. However, actinomycosis infection of the tongue is rare, it usually presents as an abscess formation, draining sinus tracts, fistulae, and tissue fibrosis. The gold standard for the diagnosis of Actinomyces is histological examination. Identification of the underlying pathogen is crucial for management of these patients. Candida is treated with antifungals, however, for actinomyces the treatment is penicillin group of antibiotics. Therefore, it is important to have awareness for actinomyces in the setting of oral thrush for appropriate treatment.Figure 1.: Endoscopic Findings.

S3639 Nitromethane Ingestion Resulting in Severe Esophageal and Pyloric Stenosis: A Case Report

S3639 Nitromethane Ingestion Resulting in Severe Esophageal and Pyloric Stenosis: A Case Report

S2898 A Unique and Challenging Presentation of Abdominal Pain in Patient of Gastric Bypass Anatomy

Introduction: We are presenting an interesting and challenging case of chronic abdominal pain in a patient of gastric bypass surgery. This patient required Endoscopic ultrasound (EUS) directed transgastric Endoscopy (EDGE) for diagnosis and management of pyloric stenosis in a patient with Roux-en-Y gastric bypass anatomy. Case Description/Methods: 61 years old female presented to emergency department with worsening upper abdominal pain for last 2 years. Patient has history of Roux-en-Y gastric bypass surgery in 2002. Patient had multiple prior evaluations with endoscopies and imaging without any significant etiology identified. She underwent repeat endoscopy with finding of a short gastric pouch and normal-appearing gastrojejunal anastomosis and jejunal limbs. An upper gastrointestinal series and small-bowel follow-through showed normal anatomy. A computed tomography of the abdomen significantly distended bypassed stomach (BS) with fluid. Upon further discussion with Radiology, there was abnormal thickening and elongation of the gastric pylorus noted. Subsequently, an EUS directed transgastric endoscopy was performed revealing significantly dilated BS. An AXIOS stent was placed between gastric pouch and BS in order to decompress as well as gaining access to pyloric channel. Tract was dilated and entered with regular gastroscope. Excessive amount of fluid was aspirated from stomach. A severe friable stenosis found at pylorus. This was only traversed with XP190N gastroscope with outer diameter of 5.4mm. Pathology showed benign inflammation. Repeat EGD was performed through the established tract. Pyloric stricture was then dilated up to 12 mm. Patient was subsequently discharged in stable condition and followed up in clinic. She reported significant improvement in symptoms. Discussion: Despite its overall benefit, there are multiple complications associated with Roux-en-Y gastric bypass. EDGE procedure has been routinely performed in order to gain access to biliary tract. Options to gain access to BS include laparoscopic assisted endoscopy versus surgical exploration. EDGE not only provided therapeutic benefit of decompressing significantly distended excluded stomach but also provided access for examining pyloric channel stenosis/thickening concerning for inflammation or neoplasm. After confirming benign nature, repeated endoscopy was performed for dilation. To our knowledge, this is among first few cases of minimally invasive management of gastric outlet obstruction in patient with gastric bypass anatomy.

The Outcome of Different Surgical Conditions in Neonates at A Tertiary Care Hospital: A Cross-Sectional Study

Aim: To determine the outcome of different surgical conditions in neonates at a tertiary care hospital Study design: A cross-sectional study Place and Duration: Department of Pediatric Surgery Chandka Medical College Children’s hospital Larkana from Nov 2020 to Nov 2021 Methodology: All the neonates with surgical conditions were admitted through emergency and OPD. The variables were age, gender, diagnosis, surgery performed, postoperative course and complications if any. Patients soon after birth to 28 days of age with neonatal surgical conditions were enrolled in the study. The diagnosis was established either with pre-operative, intra-operative or post-operatively with relevant clinical, radiological, biochemical and histopathological findings described in standard textbooks of paediatric and neonatal surgery Results: A total of 208 patients were managed. The age range was 1 hour to 28 days. Male was 159 (76.4%) and 49 (23.6%) were female. The commonest conditions presented were anorectal malformations followed by necrotizing enterocolitis. Other conditions include Hirschsprung’s Disease, Omphalocele, Gastroschisis, Duodenal and Jejuno ileal Atresia, Myelomeningocele, Infantile Hypertrophic Pyloric Stenosis, Obstructed Inguinal Hernias, sacrococcygeal teratoma and skin and soft tissue infections. Frequently performed operation was the creation of stoma (Colostomy/Ileostomy). 180 (86.53%) neonates were discharged and 24 (11.53%) neonates expired while only 4 (1.92%) neonates were referred to other centers. Conclusion: Neonatal surgical conditions carry high mortality and morbidity even at centers with all facilities available. Our results at the resource-limited centre are comparable to the centres having state of art facilities. Keywords: Neonatal surgery, Anorectal Malformations, Abdominal wall defects, Necrotizing Enterocolitis (NEC)

A Prospective Comparative Study to Assess the Management Outcomes of Patients with Infantile Hypertrophic Pyloric Stenosis Using Ramstedt’s Pyloromyotomy and Double ’Y’ Pyloromyotomy

Abstract Background: Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infancy in which the pyloric portion of the stomach becomes hypertrophied, leading to obstruction of gastric emptying. Various approaches have been tried for surgical management of IHPS. The first successful surgery was performed by Dufour and Fredet in which the hypertrophic pyloric muscle is longitudinally splitted and closed transversely. However, Ramstedt introduced extramucosal pyloromyotomy, introduced in 1912 which still remains the gold standard for surgical management of IHPS. Later on, in 2009, Alayet et al. introduced a new technique known as Alayet’s double-Y (DY) pyloromyotomy which he claimed to have a better functional outcome compared to Ramstedt’s pyloromyotomy (RP) while maintaining a safety profile similar. The objective of this study was to compare the outcome of surgical management of IHPS between DY pyloromyotomy and Ramstedt’s pyloromyotomy. Materials and Methods: It was a prospective study conducted in the Paediatric Surgery Department of SVPPGIP, SCB Medical College, Cuttack, from January 2019 to April 2022. All the IHPS cases were admitted and optimised thoroughly with regard to hydration, acid-base status and electrolyte imbalance. We have included 60 patients and were divided into two groups; every alternate patient was pooled into one group. Detailed and informed consent was taken from parents regarding the surgical procedure of their baby. The patients were selected alternatively, i.e., if one patient underwent Ramstedt’s pyloromyotomy then in the next patient Alayet’s DY pyloromyotomy procedure was done. The demographic characteristics of all patients, operative procedure performed, duration of surgery, intraoperative anaesthesia or surgical complication, post-operative vomiting patterns and weight gain data were collected and analysed in Microsoft Excel sheet and SPSS software. The student’s t-test was used to compare both groups. Results: We found that both groups were similar while considering the demographic characteristics as there were no significant statistical differences noticed in the patient population with regard to age (DY Group 42.73 ± 9.01 days vs. RP Group 40.63 ± 7.6 days; P = 0.8209), sex (DY 4F/26M vs. RP 6F/24 M), weight at presentation (DY 3.3 ± 0.33 kg vs. RP 3.2 ± 0.21 kg; P = 0.33449), symptoms and clinical condition. All patients were optimally resuscitated before proceeding to surgery with regard to hydration, electrolyte imbalance and acid-base status. While considering anaesthesia, both groups were equal in terms of it and no anaesthesia-related complications were recorded in our study. However, during the first post-operative week, a significant difference was noted between DY versus RP groups with regard to vomiting (DY 1.33 ± 0.59 days vs. RP 2.8 ± 0.76 days; P = &lt; 0.0001) and weight gain (299.86 ± 41.90 g vs. 199.03 ± 21.72 g; P = 0.008), respectively. Patients were followed up for 6 months post-operatively. No long-term complications were noticed in both groups. Weight gain after 1 month DY 577.46 ± 169.96 g versus RP 574.70 ± 170.10 g, (P = 0.949969), after 2 months DY (758.43 ± 94.53 g vs. RP 758. 8 ± 94.68 g, P = 0.98699) and after 3 months DY (593 ± 20.01 g vs. RP 591.16 ± 20.89 g, P = 0.61136). Overall, the operative time duration was the same in both groups. We had not noticed any intraoperative complications, post-surgical site infections were encountered. There was no need to redo pyloromyotomies in our study. Conclusion: Our study demonstrated that the double-Y pyloromyotomy procedure provides a better functional outcome with regard to vomiting and weight gain in the early post-operative period. It seems to be due to the wider opening of the pyloric canal at both ends of pyloromyotomy incision with a wide angle compared to Ramstedt’s pyloromyotomy. Obviously, the chance of mucosal perforation is also less as the enforce of the mucosa is divided into two directions. The method is suitable for both conventional and laparoscopic surgery. The small sample size was a limiting factor in this study. However, more studies need to be done on this technique to prove its efficacy and establish it as a standard technique for the future.

Diagnostic accuracy of palpation and ultrasonography for diagnosing infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis.

Although infantile hypertrophic pyloric stenosis (IHPS) is a well-known disease, there is no systematic review regarding the optimal diagnostic strategy. We conducted a systematic review and meta-analysis to obtain diagnostic accuracy of all methods to diagnose IHPS. According to the Preferred Reported Items for Systematic Reviews and Meta-Analysis guidelines, we searched MEDLINE and Embase to identify studies reporting sensitivity and specificity of all methods used to diagnose IHPS. Inclusion criteria were infants with suspicion of/or diagnosed with IHPS who underwent pyloromyotomy or had clinical follow-up. A random-effects model was used to obtain pooled estimates of sensitivity, specificity and area under the receiver operating characteristic curve. After screening 5364 studies, we included 43 studies with in total 6085 infants (n = 4241 IHPS; n = 1844 controls). The diagnostic sensitivity of palpation ranged from 10.0 to 93.4% and decreased over time. Different parameters for ultrasonography were found. Most used parameters were pyloric muscle thickness (PMT) ≥ 3 mm (pooled sensitivity 97.6% and specificity 98.8%), PMT ≥ 4 mm (pooled sensitivity 94.0% and specificity 98.0%) or a combination of PMT ≥ 4 mm and/or pyloric canal length ≥16 mm (pooled sensitivity 94.0% and specificity 91.7%). The AUC showed high diagnostic accuracy (0.997, 0.966 and 0.981 respectively), but large heterogeneity exists. Due to the large differences in cut-off values no meta-analysis could be conducted for pyloric canal length and pyloric diameter. Palpation has limited sensitivity in diagnosing IHPS. We showed that ultrasonography has highest diagnostic accuracy to diagnose IHPS and we advise to use PMT ≥ 3 mm as cut-off. This is the first systematic review and meta-analysis on diagnosing IHPS, which summarizes the available literature and may be used as a guideline.