scholarly journals A Prospective Comparative Study of the Outcome of Double-Y Pyloromyotomy (Alayet's Pyloromyotomy) and Ramstedt's Pyloromyotomy for the Surgical Management of Infantile Hypertrophic Pyloric Stenosis

2014 ◽  
Vol 1 (1) ◽  
pp. 15-18
Author(s):  
Md. Ansar Ali ◽  
Md. Sharifuzzaman ◽  
Md. Ashraf Ul Huq ◽  
Md. Mahbub-Ul Alam
Keyword(s):  
Weight Gain ◽  
Surgical Management ◽  
Pyloric Stenosis ◽  
Hypertrophic Pyloric Stenosis ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Postoperative Vomiting ◽  
Acid Base ◽  
Feeding Regimes ◽  
Acid Base Status ◽  
A New Technique

Background: Many innovations and approaches have been tried for the surgical management of Infantile Hypertrophic Pyloric Stenosis (IHPS) since Ramstedt’s first successful surgery almost one hundred years ago. Here a new technique focusing on the pylorus which may offer better results for this common condition.Methods: A prospective on going study of 20 patients with IHPS are carried out over a period of 15 months from July 2008 to September 2009. The patients are divided into 2 equal groups of 10 patients in each. The study is designed that all patients selected for study are optimized preoperatively with regard to hydration, acid-base status and electrolytes imbalance. All surgeries are performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes are used. The patients are operated on an alternate basis, i.e., one patient by double-Y pyloromyotomy(DY) and the next by a Ramstedt’s pyloromyotomy(RP). Data on patient demographics, operative time, anesthesia complications, Postoperative complications including vomiting and weight gain are collected. Patients are followed up for a period of 3 months postoperatively. Statistical assessments are done by using Student test.Results: No statistical differences are observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status. Significant differences are found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups are collected. Vomiting in double- Y(DY) pyloromyotomy group (1.23 ± 0.98 days) vsRamstedt’s pyloromyotomy (RP) group(2.950.99 days) p= 0.0094.Weight gain after 1st 10 days DY vs RP is ( 298 ± 57.94 gm vs193±19.8 gm p=0.0014), after 1 month (685±15.72 gm vs 498 ± 12.36 gm, p=0.0008), after 2months (670± 105.93 gm vs 455±79.76 gm, p=0.00013) and after 3 months (555±86.44 gm vs 435±47.43 gm, p=0.00098).No long-term complications are reported and no re-do pyloromyotomy is needed.Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain.DOI: http://dx.doi.org/10.3329/jpsb.v1i1.19449

scholarly journals Surgical Management of Infantile Hypertrophic Pyloric Stenosis by Double-Y Pyloromyotomy: A Better Approach

2012 ◽  
Vol 3 (2) ◽  
pp. 38-40
Author(s):  
Md. Ansar Ali ◽  
Kaniz Hasina ◽  
Abu Naim ◽  
Md. Anwar Israil ◽  
Md. Mahbub-Ul-Alam ◽  
...  
Keyword(s):  
Weight Gain ◽  
Surgical Management ◽  
Pyloric Stenosis ◽  
Hypertrophic Pyloric Stenosis ◽  
Treatment Modalities ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Postoperative Vomiting ◽  
Acid Base ◽  
Feeding Regimes ◽  
Acid Base Status

Background: Various treatment modalities have been applied for the management of infantile hypertrophic pyloric stenosis. However surgery remains the mainstay of treatment for IHPS of which Ramstedt's pyloromyotomy remains the surgical technique of choice. Objective: To see the outcome of surgical management of infantile hypertrophic pyloric stenosis by double-Y pyloromyotomy. Methods: A prospective interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. All patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy (DY) and the next by a Ramstedt's Pyloromyotomy (RP). Data on patient demographics, operative time, anaesthesia complications and postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test. Results: From July 2008 through July 2010, forty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group vs Ramstedt's pyloromyotomy (RP) group was significant (p= 0.0001). Weight gain after 1st 10 days DY vs RP is 298 ± 57.94 gm vs 193±19.8 gm (p=0.0014), after 1 month 676.67±149.84 gm vs 466.67 ± 127.71 gm (p=0.0001), after 2 months 741.33± 278.74 gm vs 490±80.62 gm (p=0.002) and after 3 months 582±36.01gm vs 453.33±51.64 gm (p=0.0001). No long-term complications were reported and no re-do pyloromyotomy was needed.Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain. J Shaheed Suhrawardy Med Coll, 2011;3 (2): 38-40 DOI: http://dx.doi.org/10.3329/jssmc.v3i2.12076

To Manage Infantile Hypertrophic Pyloric Stenosis by "Double-Y Pyloromyotomy" is a better Surgical Approach

2014 ◽  
Vol 1 (2) ◽  
pp. 143-147
Author(s):  
Md. Ansar Ali ◽  
Kaniz Hasina ◽  
Shahnoor Islam ◽  
Md. Ashraf Ul Huq ◽  
Md. Mahbub-Ul Alam ◽  
...  
Keyword(s):  
Weight Gain ◽  
Pyloric Stenosis ◽  
Hypertrophic Pyloric Stenosis ◽  
Treatment Modalities ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Postoperative Vomiting ◽  
Acid Base ◽  
Feeding Regimes ◽  
Acid Base Status ◽  
Postoperative Feeding

Background: Different treatment modalities and procedures have been tried for the management of infantile hypertrophic pyloric stenosis. But surgery remains the mainstay for management of IHPS. Ramstedt’s pyloromyotomy was described almost over a hundred years ago and to date remains the surgical technique of choice. An alternative and better technique is the double-Y pyloromyotomy, which offer better results for management of this common condition.Methods: A prospective comparative interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. The study was designed that all patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy(DY) and the next by aRamstedt’s Pyloromyotomy (RP). Data on patient demographics, operative time, anesthesia complications, postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test.Results: From July 2008 through July 2010, fourty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y(DY) pyloromyotomy group (1.21 ± 0.45days) vs Ramstedt’s pyloromyotomy (RP) group(3.03 ± 0.37days) p= 0.0001.Weight gain after 1st 10 days DY vs RP is ( 298 ± 57.94 gm vs193±19.8 gm p=0.0014), after 1 month (676.67±149.84 gm vs 466.67 ± 127.71 gm, p=0.0001), after 2months (741.33± 278.74 gm vs 490±80.62 gm, p=0.002) and after 3 months (582±36.01gm vs 453.33±51.64 gm, p=0.0001).No long-term complications were reported and no re-do yloromyotomy was needed.Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain.DOI: http://dx.doi.org/10.3329/jpsb.v1i2.19532

Infantile Hypertrophic Pyloric Stenosis

1981 ◽  
Vol 26 (3) ◽  
pp. 245-249 ◽  
Author(s):  
K. G. Mitchell ◽  
Susan M. Cachia
Keyword(s):  
Effective Treatment ◽  
Surgical Management ◽  
Pyloric Stenosis ◽  
Medical Practice ◽  
Hypertrophic Pyloric Stenosis ◽  
Cost Effective ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Royal Hospital ◽  
Sick Children

A brief review of the development of the surgical management of infantile hypertrophic pyloric stenosis is made. The incidence, investigation, management and complications of cases treated at the Royal Hospital for Sick Children, Glasgow over a period of six decades is reported. The mortality fell from 59 per cent in 1925 to 0 per cent in 1975. Pyloromyotomy in infants with hypertrophic pyloric stenosis is shown to be a very effective treatment for this potentially lethal condition and must rank as one of the most cost-effective forms of treatment in medical practice.

scholarly journals Infantile Hypertrophic Pyloric Stenosis in Postoperative Esophageal Atresia with Tracheoesophageal Fistula

2015 ◽  
Vol 4 (3) ◽  
Author(s):  
Hassan RAA ◽  
Choo YU ◽  
Noraida R ◽  
Rosida I
Keyword(s):  
Pyloric Stenosis ◽  
Tracheoesophageal Fistula ◽  
Hypertrophic Pyloric Stenosis ◽  
Typical Case ◽  
Infantile Hypertrophic Pyloric Stenosis ◽  
Feeding Intolerance ◽  
Esophageal Dysmotility ◽  
Postoperative Vomiting ◽  
Delay In Diagnosis ◽  
High Index Of Suspicion

Development of infantile hypertrophic pyloric stenosis during postoperative period in EA with TEF is rare. Postoperative vomiting or feeding intolerance in EA is more common which is due to esophageal stricture, gastroesophageal reflux and esophageal dysmotility. A typical case of IHPS also presents with non-bilious projectile vomiting at around 3-4 weeks of life. The diagnosis of infantile hypertrophic pyloric stenosis in this subset is usually delayed because of its rarity. We report a case of IHPS in postoperative EA and emphasize on high index of suspicion to avoid any delay in diagnosis with its metabolic consequences.

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