Double Incomplete Pyloromyotomy (A. Ezzat Technique): A New Technique for Infantile Hypertrophic Pyloric Stenosis:  Preliminary Study

Rozeik, Ahmed Ezzat; Elsherbini, Radi; Almaramhy, Hamdi H.

doi:10.4236/ojped.2014.44034

Cited by 2 publications

(1 citation statement)

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“…Mortality after pyloromyotomy is less than 0.4 % in most major centers and when it occurs, it is usually from fluid and electrolyte depletion in infants presenting late, and inadequately corrected electrolyte problems before surgery [ 17 , 18 ]. The overall mortality rate in this study was reported to be 4.9 % which is higher than 3.6 and 2.3 % reported in a Ghanaian and Iranian studies [ 35 , 36 ], respectively. A high mortality rate of 6.7 % was reported by Caneiro [ 32 ] in Dar es Salaam, Tanzania.…”

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confidence: 74%

Infantile hypertrophic pyloric stenosis at a tertiary care hospital in Tanzania: a surgical experience with 102 patients over a 5-year period

et al. 2015

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BackgroundInfantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. There is paucity of published data regarding this condition in our setting. This study describes the clinical presentation, mode of treatment and outcome of treatment of this disease and identifies factors responsible for poor outcome of these patients.MethodsThis was a descriptive retrospective study of infants with HPS admitted to Bugando Medical Centre and subsequently underwent surgery between February 2009 and January 2014.ResultsA total of 102 patients (M:F = 4.7:1) were studied. The median age at presentation was 5 weeks. The median duration of illness was 4 weeks. Fifty-four (52.9 %) patients occur in first-born children. Associated anomalies were reported in 7 (6.9 %) patients. Non-bilious vomiting was the most frequent symptom and it was described in all (100 %) patients. A palpable mass was found in 23.5 % of infants. The diagnosis of IHPS was made clinically in 86 (84.3 %) and by ultrasound in 16 (15.7 %) patients. The treatment was Ramstedt’s pyloromyotomy in all cases. There were 6 (5.9 %) intra-operative mucosal perforations which were repaired successively. Postoperative complication was 11.8 %. The median length of hospital stay was 12 days and it was significantly associated with prolonged pre-operative hospitalization (p = 0.001). The mortality rate was 4.9 %. Age below 2 weeks, late presentation (≥14 days), severe dehydration on admission, hypokalaemia on admission and surgical site infection were the main predictors of mortality (p < 0.001).ConclusionThis study has shown that IHPS is a common condition in our setting. Age <2 weeks, delayed presentation, prolonged preoperative hospital stay, surgical site infection and high proportion of dehydration and electrolyte disturbance were the main predictors of poor outcome. A high index of suspicion is needed in infants with non-bilious vomiting to avoid delay in diagnosis.

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