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Postoperative emesis after laparoscopic pyloromyotomy in infantile hypertrophic pyloric stenosis

C Castellani1, T Peschaut, M Schippinger

  • 1Department of Paediatric- and Adolescent Surgery, Medical University Graz, Graz, Austria.

Acta Paediatrica (Oslo, Norway : 1992)
|October 15, 2013
PubMed

Insights

Postoperative emesis in neonates after pyloric stenosis surgery can stem from infections, rapid feeding, or reflux. Reoperation for incomplete surgery is often difficult to confirm.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Neonatal Care

Background:

  • Infantile hypertrophic pyloric stenosis (IHPS) is a common neonatal surgical condition.
  • Laparoscopic pyloromyotomy (LP) is the standard surgical treatment for IHPS.
  • Postoperative emesis (PE) is a common complication following LP.

Purpose of the Study:

  • To investigate the causes of postoperative emesis (PE) in neonates who underwent laparoscopic pyloromyotomy (LP) for infantile hypertrophic pyloric stenosis (IHPS).

Main Methods:

  • Retrospective review of a hospital database from 2000-2010.
  • Inclusion of infants diagnosed with IHPS who underwent LP.
  • Statistical analysis of clinical data including feeding protocols and diagnostic tests.

Main Results:

  • Out of 43 infants meeting criteria, 21 (48.8%) experienced PE.
  • PE was significantly more frequent in the fast-track feeding protocol (FTFP) group (12/15) compared to the conventional slow feeding protocol (CSFP) group (8/21).
  • Enteric infections and gastro-oesophageal reflux (GER) were identified causes; reoperations for suspected incomplete myotomy were challenging to confirm.

Conclusions:

  • Postoperative emesis in IHPS after LP necessitates thorough evaluation for diverse causes.
  • Enteric viral infections, aggressive feeding strategies (FTFP), and GER are significant contributors to PE.
  • Challenging clinical decisions arise when considering reoperation for incomplete pyloromyotomy due to PE.
Abstract

Keywords:
EmesisEnteric viral infectionFast track feedingLaparoscopyPyloric stenosis

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