Atropine: A Cure for Persistent Post Laparoscopic Pyloromyotomy Emesis?

Area of Science:

• Pediatric Surgery
• Gastroenterology
• Pharmacology

Background:

• Hypertrophic pyloric stenosis is often treated with atropine.
• Laparoscopic pyloromyotomy may have higher rates of incomplete procedures than open surgery.
• This study investigates atropine for persistent emesis post-laparoscopic pyloromyotomy.

Purpose of the Study:

• To evaluate the efficacy of oral atropine in managing persistent emesis after laparoscopic pyloromyotomy.
• To determine if atropine reduces the need for reoperation due to incomplete pyloromyotomy.
• To assess the safety and complications associated with atropine use in this context.

Main Methods:

• Retrospective chart review of infants undergoing laparoscopic pyloromyotomy (November 1998 - November 2012).
• Oral atropine (0.01mg/kg) administered to infants with emesis persisting >48 hours postoperatively.
• Inpatients monitored until tolerance of two consecutive feedings without emesis.

Main Results:

• 24 out of 965 patients (2.5%) received oral atropine.
• Mean hospital stay for atropine group was 5.6 ± 2.6 days (3 additional days).
• No patients required reoperation for incomplete pyloromyotomy; no complications reported from atropine use.

Conclusions:

• Oral atropine is a safe and effective treatment for persistent emesis following laparoscopic pyloromyotomy.
• Atropine administration can successfully manage post-pyloromyotomy emesis, avoiding repeat surgical intervention.
• This medical management strategy offers a viable alternative to surgical revision for incomplete pyloromyotomy.