One hundred years of pyloric stenosis in the Royal Hospital for Sick Children Edinburgh
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Published on: December 20, 2014
Charles Keys1, Charlie Johnson1, Warwick Teague1
1The Royal Hospital for Sick Children, Edinburgh, UK.
Insights
Pyloric stenosis management in Edinburgh has evolved dramatically, with surgical techniques like the Rammstedt pyloromyotomy leading to a 100% survival rate today. This historical review highlights significant improvements in patient outcomes over a century.
Area of Science:
- Pediatric surgery
- Medical history
Background:
- Pyloric stenosis, a condition first reported in 1717, has seen evolving treatment strategies.
- Edinburgh's hospital, established in 1860, has a long history of managing this condition.
Observation:
- Historical records from 1910 onwards, including discharge summaries and surgical notes, were reviewed.
- Early management (1926-1936) had a high mortality rate (4/7 survivors).
- Later periods showed reduced mortality (4.08% from 1947-1956), with current series (1999-2012) achieving zero mortality.
Findings:
- The Rammstedt pyloromyotomy is identified as the key surgical advancement.
- A pyloromyotomy was performed in Edinburgh as early as February 1910.
- Contemporary management boasts a zero mortality rate and a 5.3% complication rate.
Implications:
- The study demonstrates a century-long progression in pyloric stenosis treatment, from poor outcomes to complete survival.
- Improved understanding of physiological disturbances, coupled with advances in anesthesia and microbiology, are crucial to improved outcomes.
- This historical perspective underscores the impact of surgical innovation and supportive medical advancements.
Aim:
Pyloric stenosis was first reported in 1717 and was treatable from the start of the 1900s. Our hospital opened in 1860. In this study we report the historical account of the management of pyloric stenosis in Edinburgh from 1910 to 2013.
Method:
Historic discharge summaries, theatre records, and distinguished surgeons' operation and lecture notes dating back to 1910 with regard to pyloric stenosis were identified and reviewed. We present this history and compare our contemporary data.
Results:
In February 1911, Harold Styles performed a pyloromyotomy, but did not report it at the time. However, the record of this operation and date were later published by Mason Brown in 1956. For the period 1926-1936, we report the management of 7 patients, of which only 3 survived. For the period 1947-1956, 515 patients were treated, with a mortality rate of 4.08%. Our current series for 1999-2012 has a mortality rate of zero and complication rate of 5.3%.
Conclusions:
During the period 1910 to present day in Edinburgh, pyloric stenosis has gone from being medically managed with bad outcomes to a condition with 100% survival. The only surgical advance has been the development of the Rammstedt pyloromyotomy. Of interest we document that a pyloromyotomy was performed here in February 1910. The improved outcome is mainly due to better understanding of the physiological disturbance in pyloric stenosis and advances in anaesthetics and microbiology.
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