Related Experiment Videos
Pyloromyotomy versus atropine sulfate for infantile hypertrophic pyloric stenosis
A Yamataka1, K Tsukada, Y Yokoyama-Laws
1Department of Pediatric Surgery, Juntendo University School of Medicine, Tokyo, Japan.
Insights
Atropine sulfate (atropine) offers a cost-effective medical management for infantile hypertrophic pyloric stenosis (IHPS), with outcomes comparable to surgery. A trial of atropine is recommended for IHPS management.
Area of Science:
- Pediatric Surgery
- Medical Gastroenterology
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of non-bilious vomiting in infants.
- Surgical pyloromyotomy is the traditional treatment, but medical management with atropine sulfate has emerged as an alternative.
Purpose of the Study:
- To compare the efficacy, progress, and costs of atropine sulfate versus surgical pyloromyotomy for IHPS.
- To evaluate the safety and recurrence rates of both treatment modalities.
Main Methods:
- Retrospective comparison of 34 IHPS cases (14 treated with atropine, 20 with pyloromyotomy) from 1996-1998.
- Atropine administered orally, then intravenously if needed; refractory cases underwent pyloromyotomy.
- Comparison of clinical status, physical signs, treatment progress, and costs.
Main Results:
- Atropine was effective in 11 of 14 cases, with no adverse effects reported.
- Pyloromyotomy group experienced 2 wound infections; no recurrences in either group.
- Atropine treatment resulted in lower costs and longer time to full feeding compared to pyloromyotomy.
Conclusions:
- Atropine sulfate provides a viable, cost-effective medical alternative for managing IHPS.
- Further trials of atropine are warranted for IHPS treatment.
- Both atropine and pyloromyotomy demonstrated no recurrence.
Purpose:
Atropine sulfate (atropine) and pyloromyotomy were compared for managing infantile hypertrophic pyloric stenosis (IHPS).
Methods:
From 1996 to 1998, cases of IHPS treated surgically (pyloromyotomy; n = 20) or medically (atropine; n = 14) at separate institutions were compared retrospectively with regard to status on presentation, physical symptoms and signs, progress, and costs. Atropine was given orally, then intravenously if ineffective. Refractory cases were referred for pyloromyotomy.
Results:
All subjects were matched for clinical and physiological status on admission. Oral atropine alone was effective in 11 cases, was converted to intravenous atropine in 2 cases, and was terminated in 1 case because of hematemesis. Two cases were referred for pyloromyotomy. All pyloromyotomies were successful. Atropine took on average, 2.6 days to take effect. The difference in time taken for normalization of pyloric muscle thickness between the 2 groups was not significant. Average time to return to full feeding was longer in the atropine group (P<.01). Costs were lower in the atropine group (P<.01). There were 2 wound infections in the pyloromyotomy group, but no adverse effects of atropine. There were no recurrences in either group.
Conclusion:
This study provides reasonable evidence to support a trial of atropine in IHPS.