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Current trends in the diagnosis and treatment of pyloric stenosis

Shannon N Acker1, Allan J Garcia, James T Ross

  • 1Department of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 12631 E 17th Ave, C302, Aurora, CO, 80045, USA, Shannon.acker@ucdenver.edu.

Pediatric Surgery International
|February 13, 2015
PubMed

Insights

Early diagnosis of hypertrophic pyloric stenosis (HPS) in infants has not significantly improved. While laparoscopic surgery is now standard, a quarter of HPS cases still present after one week of symptoms.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology

Background:

  • Hypertrophic pyloric stenosis (HPS) is a common cause of infant vomiting.
  • Earlier diagnosis of HPS has been observed in recent years.

Purpose of the Study:

  • To investigate if trends toward earlier diagnosis of HPS continued into the early 21st century.
  • To compare diagnostic timelines and outcomes between two patient cohorts.

Main Methods:

  • Retrospective review of medical records for patients with HPS.
  • Comparison of two cohorts: 2003-2005 (historic) and 2009-2013 (modern).
  • Analysis of patient demographics, symptom duration, and operative details.

Main Results:

  • No significant difference in age, weight, or time to physician/surgeon evaluation between cohorts.
  • Late presentation (>7 days symptoms) and elevated serum bicarbonate remained consistent.
  • Shift towards laparoscopic pyloromyotomy (99% modern vs. 57% historic) with no change in operative length or complications.

Conclusions:

  • Most infants with HPS are diagnosed early, before significant electrolyte disturbances.
  • Continued improvement in clinical awareness is needed as 25% of infants present late.
  • Laparoscopic pyloromyotomy is the predominant surgical approach.
Abstract

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