Clinical Outcomes of Surgical Treatment of Hypertrophic Pyloric Stenosis with Application of Various Operational Access

Introduction. Treatment options of congenital hypertrophic pyloric stenosis (HPS) appear to be an acute issue nowadays due to the fact that this pathology is often detected in children of the first year of life - according to statistics, the incidence rate of congenital hypertrophic pyloric stenosis in children is 3:1000 live newborns. Since there are various treatment options of the given congenital pathology, there is no general consensus in the opinions of surgeons regarding the superiority of different treatment methods. Therefore, it is necessary to search for a single most relevant treatment technique for this pathology.The aim of the study was to analyze clinical outcomes for treatment of congenital hypertrophic pyloric stenosis in children with application of various surgical techniques: open pylorotomy (transverse, circumbilical incision) and laparoscopic pylorotomy.Materials and methods. The study included 67 patients, who received treatment in Kursk Regional Pediatric Hospital №2 in 2014-2018. Patients with congenital HPS were divided into 3 groups, depending on the performed surgical interventions. Group 1 included patients who underwent an open pylorotomy with transverse access, group 2 included patients who underwent an open pylorotomy with circumbilical access, and group 3 included patients who underwent laparoscopic pylorotomy. The following parameters were used to assess the efficiency of the treatment performed: the duration of the operative intervention, the duration of stay of a child in the ICU, the duration of stay of a child in the hospital, extubation time, initiation of enteral feeding, recovery rate of enteral feeding volume. The data were statistically performed using the Mann-Whitney test to determine the significance of differences between the mean values (p0.05).Results. The study results demonstrated that the shortest duration of operational intervention was observed in patients of group 3, it constituted 41,4 3,5 minutes. In addition, patients of this group spent the shortest average time in the ICU - 4,2 0,3 days - and in the hospital in general - 12,1 0,8 days; initiation of enteral feeding in patients of this group was registered in 10,8 1,2 hours and the recovery rate of enteral feeding volume was 4,8 0,5 days.Conclusions. Having analyzed clinical outcomes for treatment of pilorostenosis in the studied groups of children, it is possible to conclude that laparoscopic pyloromyotomy is preferred to open surgical interventions not only for reasons of cosmetic result, but also according to the criteria of the postoperative course of the disease in patients.

THE COMBINATION OF LADD’S SYNDROME WITH CONGENITAL HYPERTROPHIC PYLORIC STENOSIS

Background. The combination of the two congenital pathological conditions – compression of the duodenum by embryonic cords of the peritoneum and congenital inversion of the small intestine and right half of the colon due to incomplete bowel rotation – was described in detail by W. E. Ladd in 1932, thus the pathology is known as “Ladd’s syndrome” (LS). Congenital pyloric stenosis belongs to a group of severe birth defects. The disease is based on a congenital violation of the morphological structures of the pyloric sphincter of the stomach due to hypertrophy of the circular muscle layer and interstitial tissue leading to pyloric stenosis and impaired patency in this part of the gastrointestinal tract. Objective. Demonstration of diagnostics and treatment peculiarities of a rare case of a combined pathology of the gastrointestinal tract in a newborn. Material and methods. The data from clinical observation of the patient M., 3 days old, who was treated in the neonatal Department of the Grodno regional children’s clinical hospital (GODKB) since December 2018 till March 2019. Results. The child was found to have a combination of Ladd’s syndrome with congenital hypertrophic pyloric stenosis. Successful correction of the birth defects was performed. Conclusion. We have presented a case report that hasn’t been yet described in literature. Despite the diffculties in diagnostics, the patient was discharged with recovery. The follow-up examination in 2020 revealed no abnormalities in the child’s development.

Congenital Hypertrophic Pyloric Stenosis: A Case at the Gunung Wenang Hospital Manado - North Sulawesi Indonesia

On a baby girl of 4 weeks old with the dtagnosts of congenital hypertrophic pyloric stenosis, an extremely rare case in our Hospital, surgical operation was done using the Fredet Ramsted method. The main complaint was frequent vomiting. The diagnosis was based on projectile vomiting, retarded growth, constipation, moderate dehydration and was confirmed by barium meal study. Ten days after the operation, she was discharged in a good condition.