Pyloroplasty in infancy and childhood

Twenty-nine children under 18 years of age underwent pyloroplasty alone or together with other abdominal operations during a 6-year period. The 21 males and 8 females ranged in age from 2 weeks to 17 years (mean, 54 months). Peptic ulcer disease was the indication for operation in only 6 patients, whereas 16 patients underwent pyloroplasty for functional or mechanical gastric outlet obstruction; 8 had the antral dysmotility syndrome. Other indications included colon interposition in five patients and gastric resection and esophagogastric devascularization in one patient each. Only five patients had concomitant vagotomy. Ten other patients with antral dysmotility syndrome were successfully managed medically. Follow-up ranged from 2 months to 6 years (mean, 30 months). Excellent catch-up weight gain occurred in over 90% of children with functional or mechanical gastric outlet obstruction, with the best results obtained in children with antral dysmotility syndrome. One patient had transitory dumping symptoms following colon interposition with pyloroplasty which remitted with diet changes. Two patients eventually died of the underlying disease (familial dysautonomia, gastric cancer). There were two major complications, respiratory arrest and wound dehiscence, each occurring following emergency operations for peptic ulcer disease. Pyloroplasty was effective in improving gastric emptying and produced minimal morbidity even in the absence of vagotomy. The indications for pyloroplasty in children are different than for adults.