Pyloric stenosis a 100 years after Ramstedt

Georgoula, Christina; Gardiner, Mark

doi:10.1136/archdischild-2011-301526

Cited by 42 publications

(49 citation statements)

References 26 publications

(17 reference statements)

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“…Prior to Ramstedt's pyloromyotomy in 1911, paediatricians were reluctant to refer their patients for operative management of HPS as it demonstrated no improvement in mortality over conservative management. 13 Ramstedt's success combined with advancements in intravenous fluid resuscitation techniques, earlier diagnosis availability of biochemical investigations and ultrasound as well as improved anaesthetic techniques have reduced mortality to essentially zero in high-income countries. The laparoscopic approach is now becoming more accepted into routine practice and has been shown to both reduce hospital LOS and improve the time to full postoperative feeds.…”

Section: Discussionmentioning

confidence: 99%

Presentation and outcomes in hypertrophic pyloric stenosis: An 11‐year review

Vinycomb

Laslett

Gwini

et al. 2019

J Paediatrics Child Health

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Aim: To evaluate the trend in presentation and postoperative outcomes of infants with hypertrophic pyloric stenosis (HPS) over the last decade. Methods: This was a multicentre retrospective study in two tertiary paediatric centres between 2005 and 2015 inclusive. Participants included 626 infants who underwent a pyloromyotomy for HPS. We collected data on presentation features (age, weight, clinical signs, blood gas results, ultrasound findings) and postoperative outcomes (length of stay (LOS), complications, time to first postoperative feed). Results: No trend was identified during the study period with regards to age, weight, biochemical findings (pH, chloride, base excess) or preoperative ultrasound measurements. There was a downtrend in the number of palpated tumours over time, with a mean of 36% of tumours clinically palpated. Pyloric wall thickness had a moderate association with LOS in patients admitted for >8 days (correlation = 0.4752) but had a weak negative association with shorter lengths of stay (≤8 day, correlation = −0.094). Overall, median time to first feed was 7.80 h and improved yearly during the study period (hazard ratio = 1.07). Conclusions: Patients presenting with HPS are not being identified at an earlier age or with fewer biochemical derangements, in contrast to our initial perceptions. Subsequently, biochemical derangements can still play an important role in the diagnosis of HPS, and attention needs to be given to fluid management and electrolyte correction in all patients with HPS.

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Section: Discussionmentioning

confidence: 99%

Presentation and outcomes in hypertrophic pyloric stenosis: An 11‐year review

Vinycomb

Laslett

Gwini

et al. 2019

J Paediatrics Child Health

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“…This observation was echoed by the finding that the time in hours to surgical intervention from admission was also reduced in the uncorrected infants from 50 h (40. 3 …”

Section: Secondary Outcomesmentioning

confidence: 97%

Implementation of a care pathway for infantile hypertrophic pyloric stenosis reduces length of stay and increases parent satisfaction

Wetherill

Melling

Rhodes

et al. 2015

International Journal of Care Coordination

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Introduction: Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical condition, but there are no guidelines regarding preoperative fluid resuscitation. Our aim was to evaluate a novel consensus care pathway for IHPS, incorporating a standardized fluid and electrolyte replacement regime. Methods: One hundred patients were initially reviewed and compared to thirty-three patients following the introduction of a clinical pathway, whereby infants requiring electrolyte correction received 150 ml/kg/24 h of 0.45% saline, 5% dextrose and 10 mmol KCl, with systematic blood sampling until correction was achieved. We measured time to electrolyte correction, time to surgery and total length of hospitalization. Data were described using the median and interquartile range, and differences between the groups' categorical and continuous data were described using Chisquared and the Mann-Whitney U-tests, respectively. Results: Time in hours taken to correct electrolytes was reduced: 25(16.5-42) versus 9.5(4.5-24.75) p ¼ 0.004. Time to surgery from admission in uncorrected patients decreased from 50(40.25-66.75) to 39(28.75-41.75) p ¼ 0.018. Subsequently, there was a reduction in total length of stay: 94(71-93.5) versus 75(64.5-93.5) p ¼ 0.025. Parental satisfaction increased from 77% in the pre-pathway group to 83% in the pathway group. Conclusion: A consensus care pathway for IHPS reduces the time taken to correct preoperative electrolyte abnormalities, decreases length of hospitalization and improves parental satisfaction.

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“…However, in many cases, it is associated with genetic syndromes including Cornelia de Lange and Smith-Lemli-Opitz syndromes as well as chromosome 8 and 17 translocations and (partial) trisomy 9 [ 150 ].…”

Section: Pyloric Stenosismentioning

confidence: 98%