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Infantile hypertrophic pyloric stenosis: long-term audit from a general surgical unit
Insights
Ramstedt's pyloromyotomy is a safe and effective treatment for infantile hypertrophic pyloric stenosis (IHPS). This surgical approach in a general unit demonstrated acceptable morbidity and minimal mortality in 229 infants.
Area of Science:
- Pediatric Surgery
- Gastroenterology
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical condition in infants.
- Accurate diagnosis and timely surgical intervention are crucial for favorable outcomes.
Purpose of the Study:
- To review the 22-year experience of a general surgical unit in treating IHPS.
- To evaluate the safety, efficacy, and outcomes of Ramstedt's pyloromyotomy.
Main Methods:
- Retrospective review of 229 IHPS patients treated over 22 years.
- Analysis of patient demographics, diagnostic methods, surgical procedures, and post-operative outcomes.
- Assessment of morbidity (wound infection, dehiscence, mucosal penetration) and mortality.
Main Results:
- Ramstedt's pyloromyotomy was performed in 229 infants with IHPS.
- Median age was 6 weeks; male:female ratio was 3.6:1.
- Diagnosis was primarily clinical (92.6%).
- 74% underwent surgery within 5 days of admission.
- Median post-operative stay was 10 days.
- Wound morbidity was 10.0% (infection 7.3%, dehiscence 2.6%), reduced in the latter half of the series.
- Mucosal penetration suspected in 14.8%; repeat pyloromyotomy in 1.3%.
- Mortality was 0.4%, attributed to fluid/electrolyte imbalance in an early case.
Conclusions:
- Ramstedt's pyloromyotomy is a safe and effective surgical treatment for IHPS.
- General surgical units can achieve acceptable morbidity and minimal mortality rates.
- Improvements in wound closure techniques contributed to reduced wound morbidity.
Abstract:
This article describes a 22 year experience of a general surgical unit in the treatment of infantile hypertrophic pyloric stenosis (IHPS). The hospital course of 229 IHPS patients is reviewed. The male:female ratio was 3.6:1, median age 6 weeks (range 2-26 weeks) with a positive family history in 8.3%. The diagnosis of IHPS was established clinically by palpation of a "pyloric tumour" during a pre operative test meal/clinical examination in 92.6%; in the remainder, the diagnosis was made radiologically. Ramstedt's pyloromyotomy was performed within 5 days of admission in 74% of patients and within 10 days of admission in 89%. The median post-operative hospital stay was 10 days (range 3-60 days). Wound morbidity occurred in 10.0% wound infection (7.3%) and wound dehiscence (2.6%). However, wound morbidity was reduced in the second half of the series, partly by greater utililisation of non-absorbable suture in place of chromic catgut for wound closure. Mucosal penetration was suspected in 14.8% of cases. Repeat pyloromyotomy was necessary in 1.3%. One baby died (0.4%)- this was in the early part of the series and was directly attributable to fluid and electrolyte disorder. We conclude that Ramstedt's pyloromyotomy for infantile hypertrophic pyloric stenosis can be performed with acceptable morbidity and minimal mortality in a general surgical unit.