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[Towards reasoned early surgical treatment for hiatal hernia in the infant (author's transl)]
Insights
Early surgery for infantile hypertrophic pyloric stenosis (IHPS) and malrotation with midgut volvulus (MGT) in newborns is recommended. Endoscopic evaluation guides surgical timing, improving outcomes and reducing complications like peptic stenosis.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatal Care
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) and malrotation with midgut volvulus (MGT) can lead to severe complications.
- Peptic stenosis is a significant risk in newborns with these conditions, even with medical management.
Purpose of the Study:
- To evaluate the efficacy of early surgical intervention for IHPS and MGT in newborns.
- To determine optimal timing for surgical treatment based on endoscopic findings.
Main Methods:
- Retrospective review of 51 cases of IHPS and MGT treated surgically.
- Analysis of outcomes for infants operated on before and after two months of age.
- Emphasis on endoscopic examination for guiding surgical indications.
Main Results:
- Early surgical treatment (before 2 months) was associated with improved outcomes and no mortality.
- Endoscopic evaluation proved more accurate than clinical or radiological data for surgical decision-making.
- Reduced incidence of recurrence and peptic stenosis observed with early surgical intervention.
Conclusions:
- Early surgical intervention is a legitimate and effective treatment for newborns with IHPS and MGT.
- Rigorous medical treatment should not exceed one month if esophagitis persists, as confirmed by endoscopy.
- Endoscopic findings are crucial for guiding surgical indications and improving patient outcomes.
Abstract:
The authors report 2 cases of HH and MCT in newborn of 1 1/2 and 5 months old who quickly develop a peptic stenosis despite a good medical treatment. Reviewing 51 cases of early surgical treatment (29 cases operated on before 2 months of age), they estimate legitimal an early surgical treatment for HH and MCT in newborn. They insist on the necessity to begin with a rigourous medical treatment, which cannot exceed one month if an oesophagitis persist (documented by a good and acurate endoscopic examination). This examination is the guide line for the surgical indication and is more acurate than the clinical and radiological informations. They point out the absence of mortality and the improvement of the results if the patients are operated on before 2 months old. In the literature ones can observe that the incidence of recurrence and peptic stenosis is decreased when the patients are operated on early.