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A 9-year single center experience with circumumbilical Ramstedt's pyloromyotomy
Y El-Gohary1, B H Yeap, G Hempel
1Our Lady's Children's Hospital, Paediatric Surgery, Dublin, Ireland. gohary77@yahoo.com
Insights
Ramstedt
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Infant Health
Background:
- Pyloric stenosis is a frequent cause of infant vomiting.
- Ramstedt's pyloromyotomy is the standard surgical treatment.
- The circumumbilical incision is a common surgical approach.
Purpose of the Study:
- To evaluate the safety and efficacy of the circumumbilical incision for pyloric stenosis treatment.
- To analyze the relationship between postoperative emesis and feeding times.
- To assess the impact of feeding protocols on hospital stay duration.
Main Methods:
- Retrospective review of 513 patient records from 2000-2008.
- Analysis of surgical outcomes, including complications and postoperative emesis.
- Statistical analysis of the time to initial feeds and hospital stay.
Main Results:
- A total of 513 infants (440 males, 73 females) were included.
- The overall complication rate was 6%.
- Average postoperative emesis was 1.9 episodes, with a median hospital stay of 2 days.
Conclusions:
- Ramstedt's pyloromyotomy via the circumumbilical approach is safe and feasible for treating pyloric stenosis.
- Early establishment of postoperative feeds is associated with shorter hospital stays.
- This approach offers a low complication rate in the era of minimally invasive surgery.
Introduction:
Pyloric stenosis is a common cause of vomiting in infancy and is usually treated with a Ramstedt's pyloromyotomy. In this study we retrospectively reviewed our experience with the circumumbilical incision for the treatment of pyloric stenosis with a particular emphasis on the relation between postoperative emesis and postoperative time to feeds.
Material And Method:
The medical records of all patients undergoing pyloromyotomy for IHPS from January 2000 to December 2008 were reviewed retrospectively. Patient details were recorded and statistically analyzed using SPSS version 13. We reviewed our experience looking specifically at the postoperative time to initial feeds as a way of minimizing hospital stay.
Results:
513 patients' notes were available for the study. There were 440 males and 73 females (M:F ratio 6:1). Median age at operation was 40 days (2-194 days) and a positive family history was obtained in 11.9%. Median duration of symptoms was 10 days (range 1-60 days). There were 31 (6%) complications related to surgery. The average number of postoperative emesis episodes was 1.9. The median postoperative hospital stay was 2 days (1-60). The average time to feeding was 20 h (1-69).
Conclusion:
This is a large single-center retrospective study where, in the era of minimally invasive surgery, Ramstedt's pyloromyotomy via the circumumbilical approach has a low rate of complications and is a safe and feasible method to treat pyloric stenosis. The establishment of feeds soon after surgery minimizes the postoperative in-hospital stay.
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