Treatment Of Infantile Hypertrophic Pyloric Stenosis Research Articles

Database analysis of oral atropine treatment of infantile hypertrophic pyloric stenosis. A ten-year single center experience

Background/Aim. Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of surgery in newborns and young infants. Conservative treatment of IHPS is of great importance because it spares the newborn from stress caused by surgery and general anesthesia. The aim of this study was to evaluate the impact of various oral administration regimens of atropine on its efficacy in treating IHPS. Methods. The study included 45 patients with IHPS, conservatively treated by atropine sulfate in the period from 2006 to 2016. Clinical examination, laboratory analysis, and ultrasonography were performed on all patients on admission. The efficacy of treatment with different oral dosage regimens was analyzed and potential predictive factors of the negative outcome were defined. The evaluation of the success of the treatment was statistically analyzed by the method of the multivariate logistic regression model. Results. Out of 45 patients, 36 (80%) were successfully cured (p = 0.0008, without the need for surgery and without any complications. Gender prevalence, age, birth weight, body weight on admission, duration of symptoms, pyloric muscle thickness, and length had no statistically significant individual effect on the success of the atropine treatment. Patients who received a progressively increased dose of atropine had an 18 times higher risk of surgery, patients with hypochloremic alkalosis (HCA) had a 15 times higher risk, while others, with more than 5 vomitings within the first three days of the therapy, were 9 times more likely to be surgically treated. Conclusion. High success rate and no side effects represent an orally administered atropine treatment as a valid alternative choice for non-operative management of IHPS. Administration of initially high doses was shown to be more effective in relation to gradually increased oral doses of atropine sulfate. HCA and continued vomiting are considered as potential predictive factors of negative outcomes of the atropine treatment.

Efficacy of Medical Treatment for Infantile Hypertrophic Pyloric Stenosis: A Meta-analysis

Infantile hypertrophic pyloric stenosis (IHPS) is a common disease in infancy. Pyloromyotomy is universally considered the treatment for IHPS; however, oral or intravenous atropine has been reappraised for the treatment of IHPS in the past 20years. We investigated the efficacy of atropine in the medical management of IHPS by using meta-analysis and investigated the sonographic changes of the pyloric canal, as well as the efficacy and adverse effects of atropine. Information was retrieved from PubMed, Ovid, and MEDLINE. The efficacy and adverse effects of atropine treatment for IHPS were reviewed using the standard process of meta-analysis. Eleven articles were obtained. Five reports showed that 77 of 110 (70%) infants who were administered oral atropine benefitted by the induced remission of IHPS. Six reports showed that 288 of 345 (83.5%) patients who were treated initially with intravenous atropine then changed to oral atropine showed beneficial effects and had no serious side effects. Time to pyloric muscle normalization ranged from 5weeks to 15months. The study results indicate that atropine is a possible alternative treatment for IHPS, particularly in infants with major concurrent disease, and is safe without obvious side effects.

Incidence and concurrent laparoscopic repair of hypertrophic pyloric stenosis and patent processus vaginalis.

Incidence and concurrent laparoscopic repair of hypertrophic pyloric stenosis and patent processus vaginalis.

Double Incomplete Pyloromyotomy (A. Ezzat Technique): A New Technique for Infantile Hypertrophic Pyloric Stenosis: Preliminary Study

Background-Purpose: The study aimed to see the outcome of Double Incomplete Pyloromyotomy as new technique for surgical management of infantile hypertrophic pyloric stenosis (IHPS). Methods: This study was conducted in pediatric surgery unite, Zagazig University Hospital, Egypt. Fifteen patients were included in this study (11 male and 4 female) with IHPS from January 2012 to January 2013. Under general anesthesia, two longitudinal separated incisions at different planes as pyloromyotomy. Results: Postoperative vomiting and weight gain were recorded. Follow up period was 3 months. Vomiting improved within first 48 hours then stopped after that. Weight gain significantly increased after theoperation when compared preoperatively. Conclusion: Double Incomplete Pyloromyotomy is a new, safe and effective procedure for treatment of infantile hypertrophic pyloric stenosis.

İnfantil Hipertrofik Pilor Stenozu Gelişiminde Mevsimsel Etki

Objective: The aim of this report was to determine if seasonal variation exists in the incidence of pyloric stenosis and to review the management of infantile hypertrophic pyloric stenosis (IHPS) in a single tertiary pediatric hospital over a seven-year period. Material and Methods: We conducted a retrospective chart review of all patients who underwent pyloromyotomy between October 2004 and October 2011. Patient data and laboratory results on admission were recorded from medical charts. The total and postoperative length of stay was calculated from the date of admission, surgery and discharge. Patients were divided into four groups according to seasons as winter, spring, summer and autumn. Results: A total of 55 pyloromyotomies were performed. Forty-seven patients were male (85.5%) and 8 were female (14.5%). The age distribution of the patients varied from 3 weeks to 13 weeks (median 6 weeks). There was no perioperative mortality. Oral feeding was achieved by 24 hours in 78.2% of infants and there was persistent vomiting in only 30.9%. There was no significant difference between the groups in terms of age, gender, weight, plasma pH, HCO3, Cl-, and K+ values; in addition, ultrasonographic findings were similar in each group. The highest rate of pyloromyotomy was in spring and the lowest in winter and summer; this difference was statistically significant (p=0.0049). Conclusion: In conclusion, seasonal variation of the hypertrophic pyloric stenosis suggests a possible etiological role for environmental factors and pyloromyotomy is the best treatment of IHPS that can be undertaken safely in specialized pediatric centers.

Infantile Hypertrophic Pyloric Stenosis

Infantile hypertrophic pyloric stenosis(IHPS), which occurs three of 1,000 live births, is a major cause of nonbilious vomiting of early infancy but its etiology and pathogenesis are still obscure. The operation of pyloromyotomy as described by Ramstedt in 1912 remains the standard of care for the treatment of IHPS. From January 1993 to October 1996, 35 infants with IHPS were surgically treated and the following results were obtained. 1. Thirty-five patients comprised 32 males and 3 females, and the ratio of male to female was 10.7:1. 2. The most prevalent age group was between 2 weeks and 8 weeks. 3. Of 35 infants, first born babies were 23 cases(65.7%). 4. Breast feeding was in 23 cases(65.7%). 5. The body weight percentile at admission was lower than 50 percentile in all 35 cases. 6. Onset of symptoms was predominantly between 1week and 2 weeks in 11 cases(31.4%). 7. All had a history of nonbilious vomting, generally projectile in nature. 8. In the measured serum electrolytes, hypokalemia was noted in 9 cases(25.7%), hypochloremia was observed in 14 cases(40.0%). 9. In the preoperative ultrasonography, the average muscle thickness, diameter, and length of the pylorus were 6.2mm, 12.1mm, and 17.9mm, respectively. 10. Among 35 cases, significant sonographic criteria of IHPS, muscle thickness of 5mm or more, were noted in 26 cases(83.9%). 11. A total of seven associated anomalies were noted in six patients. 12. All 35 cases were treated with Fredet-Ramstedt pyloromyotomy. 13. There were postoperative complications of wound infection in 2 cases. Intermittent nonprojectile vomiting was presented in 8 cases(22.9%) after operation, but one of them was relieved in 13 days and the rest were relieved within one week by adjustment of oral intake.