Pyloric stenosis: an enigma more than a century after the first successful treatment

El-Gohary, Yousef; Abdelhafeez, Abdelhafeez; Paton, Elizabeth A.; Gosain, Ankush; Murphy, Andrew J.

doi:10.1007/s00383-017-4196-y

Cited by 23 publications

(19 citation statements)

References 48 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In 1986, Tan and Bianchi introduced the supra-umbilical crescent incision along the folds of the umbilical scar itself and approached the peritoneum through the fascia of the abdominal muscles to limit the esthetic damage caused by the incision suggested by Ramstedt. Both intra- and postoperative complications were similar to those with the classic approach, and the esthetic result was excellent [ 11 12 13 14 15 16 17 ].…”

Section: Discussionmentioning

confidence: 92%

Hypertrophic Pyloric Stenosis: 10 Years' Experience with Standard Open and Laparoscopic Approach

Zampieri

Corato

Scirè³

et al. 2021

Pediatr Gastroenterol Hepatol Nutr

View full text Add to dashboard Cite

Purpose Hypertrophic pyloric stenosis (HPS) is the most common cause of gastric obstruction in newborns. Extra-mucosal pyloromyotomy can be performed through a small laparotomy or laparoscopy. The aim of this study was to compare the two surgical techniques. We also analyzed the incidence of HPS in infants in the last 10 years in relation to the demographic trend of our province. Methods We analyzed all the cases of HPS treated at our Unit between January 2010 and December 2019. The data were obtained from operating systems. Data about the demographic trends, in particular, the number of births and the population residing in the province of Verona from 2010 to 2019, were also retrieved. Results During the study period, 60 patients were treated for HPS and met the inclusion criteria. Of these, 56 males and 4 females with an average age of 38±14 days at surgery were included. No differences were found in terms of the duration of surgery, post-operative complications, duration of hospitalization, and weight at the time of surgery. The only statistically significant data was the chlorine level in cases with and without post-operative vomiting (97±3.5 vs. 102±3.3 mmol/L, p <0.05). There was a lower incidence of HPS from 2014 to 2019; however, there was no significant evidence regarding the correlation between this and the reduced birth rate recorded in the province of Verona during the same period. Conclusion Although laparoscopic pyloromyotomy is a highly complex procedure, it is a feasible alternative to the classic open technique.

show abstract

Section: Discussionmentioning

confidence: 92%

Hypertrophic Pyloric Stenosis: 10 Years' Experience with Standard Open and Laparoscopic Approach

Zampieri

Corato

Scirè³

et al. 2021

Pediatr Gastroenterol Hepatol Nutr

View full text Add to dashboard Cite

show abstract

“…The ultrasound criteria for the hypertrophic pyloric stenosis include muscle wall thickness >4 mm, length of pyloric canal >16 mm, and diameter of the pylorus >12 mm [9,10]. Initial treatment is placement of a nasogastric tube, cessation of feeding and rehydration, and correction of electrolyte and metabolic imbalances [11].…”

Section: Introductionmentioning

confidence: 99%

“…Although there are reports in literature of treatment of hypertrophic pyloric stenosis with atropine-sulfate, in most centers the standard approach to treatment of this condition is surgery, i.e., pyloromyotomy. The success rates of conservative treatment with atropinesulfate varies between 68 and 87% [11][12][13][14]. The surgical approach involves pyloromyotomy, which can be performed in the traditional open way or, more recently, by laparoscopic approach [6,11].…”

Section: Introductionmentioning

confidence: 99%

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

et al. 2021

View full text Add to dashboard Cite

Background: The standard of treatment for infants with hypertrophic pyloric stenosis is still pyloromyotomy. Recently, in most of the pediatric surgery centers laparoscopic pyloromyotomy has become popular. The aim of the present study is to compare the outcomes of treatment in infants with hypertrophic pyloric stenosis between traditional open approach and laparoscopic pyloromyotomy using 3-mm electrocautery hook. Methods: A total of 125 infants, 104 (83.2%) males, with median age 33 (interquartile range, IQR 24, 40) days, who underwent pyloromyotomy because of hypertrophic pyloric stenosis, between 2005 and 2021, were included in the retrospective study. Of that number 61 (48.8%) infants were allocated to the open group and 64 (51.2%) to the laparoscopic group. The groups were compared in regards to time to oral intake, duration of surgery, the type and rate of complications, rate of reoperations, frequency of vomiting after surgery, and the length of hospital stay. Results: No differences were found with regards to baseline characteristics between two investigated groups. Laparoscopic approach was associated with significantly better outcomes compared to open approach: shorter duration of surgery (35 min (IQR 30, 45) vs. 45 min (40, 57.5); p = 0.00008), shorter time to oral intake (6 h (IQR 4, 8) vs. 22 h (13.5, 24); p < 0.00001), lower frequency of postoperative vomiting (n = 10 (15.6%) vs. n = 19 (31.1%)), and shorter length of postoperative hospital stay (3 days (IQR 2, 3) vs. 6 days (4.5, 8); p < 0.00001). In regards to complications and reoperation rates, both were lower in the laparoscopic pyloromyotomy group but the differences were not statistically significant (p = 0.157 and p = 0.113, respectively). The most common complication in both groups was mucosal perforation (open group, n = 3 (4.9%); laparoscopic group, n = 2 (3.1%)) followed by wound infection in open group, n = 3 (4.9%). No cases of wound infection were recorded in the laparoscopic group. Conclusion: Open and laparoscopic pyloromyotomy are equally safe and effective in treatment of hypertrophic pyloric stenosis. Laparoscopic technique is associated with faster recovery, shorter duration of surgery and shorter duration of hospital stay.

show abstract

“…This defect usually presents at 2-12 weeks after birth, often in a previously healthy infant, with peak onset at week 5 (Jobson & Hall, 2016). IHPS is one of the most frequently treated surgical conditions in children (El-Gohary, Abdelhafeez, Paton, Gosain, & Murphy, 2018). If left untreated, IHPS can lead to dehydration, weight loss, metabolic alkalosis and, in severe cases, death (Spicer, 1982).…”

mentioning

confidence: 99%

Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: A multistate, population‐based retrospective study, 1999–2010

Kapoor

Kancherla

Cao

et al. 2018

Birth Defects Research

View full text Add to dashboard Cite

Background Antecedents for infantile hypertrophic pyloric stenosis (IHPS) vary across studies; therefore, we conducted a multistate, population‐based retrospective study of the prevalence and descriptive epidemiology of IHPS in the United States (US). Methods Data for IHPS cases (n = 29,554) delivered from 1999–2010 and enumerated from 11 US population‐based birth defect surveillance programs, along with data for live births (n = 14,707,418) delivered within the same birth period and jurisdictions, were analyzed using Poisson regression to estimate IHPS prevalence per 10,000 live births. Additional data on deliveries from 1999–2005 from seven of these programs were analyzed using multivariable logistic regression to estimate adjusted prevalence ratios (aPR)s and 95% confidence intervals (CI)s for selected infant and parental characteristics. Results Overall, IHPS prevalence from 1999–2010 was 20.09 (95% CI = 19.87, 20.32) per 10,000 live births, with statistically significant increases from 2003–2006 and decreases from 2007–2010. Compared to their respective referents, aPRs were higher in magnitude for males, preterm births, and multiple births, but lower for birth weights <2,500 g. The aPRs for all cases increased with decreasing parental age, maternal education, and maternal parity, but decreased for parental race/ethnicity other than non‐Hispanic White. Estimates restricted to isolated cases or stratified by infant sex were similar to those for all cases. Conclusions This study covers one of the largest samples and longest temporal period examined for IHPS in the US. Similar to findings reported in Europe, estimates suggest that IHPS prevalence has decreased recently in the US. Additional analyses supported associations with several infant and parental characteristics.

show abstract

Pyloric stenosis: an enigma more than a century after the first successful treatment

Cited by 23 publications

References 48 publications

Hypertrophic Pyloric Stenosis: 10 Years' Experience with Standard Open and Laparoscopic Approach

Hypertrophic Pyloric Stenosis: 10 Years' Experience with Standard Open and Laparoscopic Approach

The Safety and Effectiveness of Laparoscopic Pyloromyotomy Using 3-mm Electrocautery Hook versus Open Surgery for Treatment of Hypertrophic Pyloric Stenosis in Infants

Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: A multistate, population‐based retrospective study, 1999–2010

Contact Info

Product

Resources

About