MANAGEMENT OF INFANTILE HYPERTOPHIC PYLORIC STENOSIS WITH OPEN PYLOROMYOTOMY
DOI:
https://doi.org/10.69656/pjp.v21i2.1646Keywords:
Infantile hypertrophic pyloric stenosis, Mortality, Pyloromyotomy, Vomiting, Weight lossAbstract
Background: Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of gastric outlet obstruction in early infancy, primarily affecting males. Prompt diagnosis and surgical intervention are essential to prevent complications and ensure favourable outcomes. Objective of this study was to evaluate the characteristics and outcomes of surgical management of IHPS using open pyloromyotomy. Methods: A case-series conducted at the Paediatric Surgery Department, Bahawal Victoria Hospital, Bahawalpur from 31 Jan to 30 Jun 2023. Forty-seven children aged 1 day to 3 months diagnosed with IHPS and scheduled for open pyloromyotomy were included. Diagnosis was based on non-bilious projectile vomiting and/or palpable pyloric mass, confirmed on ultrasonography. All underwent surgery under general anaesthesia following standard protocols. Results: Of 47 infants, 32 (68.1%) were boys and 15 (31.9%) girls. Mean age was 5.1±3.2 weeks; 34 (72.3%) were aged 2–6 weeks. Preterm birth and Caesarean delivery were recorded in 28 (59.6%) each. Common symptoms included projectile vomiting (100%), weight loss (55.3%), and visible gastric peristalsis (51.1%). Mean surgery duration was 37.3±7.4 minutes. Postoperative vomiting occurred in 16 (34.0%), surgical site infection in 4 (8.5%), and sepsis in 3 (6.4%). Mortality was 6.4%. Conclusion: IHPS predominantly affects boys and presents with projectile vomiting. Open pyloromyotomy resulted in favourable outcomes, though 6.4% mortality was observed.
Pak J Physiol 2025;21(2):42?4, DOI: https://doi.org/10.69656/pjp.v21i2.1646
Downloads
References
Boybeyi-Turer O, Çelik HT, Arslan UE, Soyer T, Tanyel FC, Kiran S. Protocol: A systematic review and meta-analysis of the role of fetal and infantile environmental exposure in etiopathogenesis of infantile hypertrophic pyloric stenosis. PLoS One 2021;16(2):e0247003.
Zvizdic Z, Halimic T, Milisic E, Jonuzi A, Halimic JA, Vranic S. Infantile hypertrophic pyloric stenosis in Bosnia and Herzegovina: A retrospective cohort study from the largest tertiary care facility. Asian J Surg 2022;45(9):1694–7.
Boybeyi-Turer O, Celik HT, Arslan UE, Soyer T, Tanyel FC, Kiran S. Environmental exposure in the etiology of infantile hypertrophic pyloric stenosis: a systematic review and meta-analysis. Pediatr Surg Int 2022;38(7):951–61.
Tolefac PN, Tamambang RF, Yeika E, Mbwagbaw LT, Egbe TO. Ten years analysis of stillbirth in a tertiary hospital in sub-Sahara Africa: a case control study. BMC Res Notes 2017;10(1):447.
Obaid YY, Toubasi AA, Albustanji FH, Al-Qawasmeh AR. Perinatal risk factors for infantile hypertrophic pyloric stenosis: A systematic review and meta-analysis. J Pediatr Surg 2023;58(3):458–66.
Georgoula C, Gardiner M. Pyloric stenosis a 100 years after Ramstedt. Arch Dis Child 2012;97:741–5.
Lunger F, Staerkle RF, Muff JL, Fink L, Holland-Cunz SG, Vuille-dit-Bille RN. Open versus laparoscopic pyloromyotomy for pyloric stenosis—A systematic review and meta-analysis. J Surg Res 2022;274:1–8.
Binet A, Klipfel C, Meignan P, Bastard F, Cook AR, Braïk, et al. Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a survey of 407 children. Pediatr Surg Int 2018;34:421–6.
Parikh RM, Ata A, Edwards MJ. A contemporary review of surgical approach and outcomes in pediatric hypertrophic pyloric stenosis. J Surg Res 2023;285:142–9.
Tan H, Roy P, Lakhoo K. Bilious vomiting in infantile hypertrophic pyloric stenosis. Afr J Paediatr Surg 2007;4(2):101–2.
Chalya PL, Manyama M, Kayange NM, Mabula JB, Massenga A. Infantile hypertrophic pyloric stenosis at a tertiary care hospital in Tanzania: a surgical experience with 102 patients over a 5-year period. BMC Res Notes 2015;8:690.
Oomen MW, Hoekstra LT, Bakx R, Ubbink DT, Heij HA. Open versus laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: A systematic review and meta-analysis focusing on major complications. Surg Endosc 2012;26:2104–10.
Sathya C, Wayne C, Gotsch A, Vincent J, Sullivan KJ, Nasr A. Laparoscopic versus open pyloromyotomy in infants: a systematic review and meta-analysis. Pediatr Surg Int 2017;33:325–33.
Ndongo R, Tolefac PN, Tambo FFM, banda MH, Ngowe MN, Fola O, et al. Infantile hypertrophic pyloric stenosis: a 4-year experience from two tertiary care centres in Cameroon. BMC Res Notes 2018;11(1):33.
Panteli C. New insights into the pathogenesis of infantile pyloric stenosis. Pediatr Surg Int 2009;25(12):1043–52.
Leong MM, Chen SC, Hsieh CS, Chin YY, Tok TS, Wu SF, et al. Epidemiological features of infantile hypertrophic pyloric stenosis in Taiwanese children: a nation-wide analysis of cases during 1997–2007. PLoS One 2011;6(5):e19404.
Ismail I, Elsherbini R, Elsaied A, Aly K, Sheir H. Laparoscopic vs. open pyloromyotomy in treatment of infantile hypertrophic pyloric stenosis. Front Pediatr 2020;8:426.
Leclair MD, Plattner V, Mirallie E, Lejus C, Nguyen JM, Podevin G, et al. Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a prospective, randomized controlled trial. J Pediatr Surg 2007;42:692–8.
Nmadu PT. Alterations in serum electrolytes in congenital hypertrophic pyloric stenosis: a study in Nigerian children. Ann Trop Paediatr 1992;12(2):169–72.
Collaborative G. Determinants of morbidity and mortality following emergency abdominal surgery in children in low-income and middle-income countries. BMJ Glob Health 2016;1(4):e000091.
Muse AI, Hussein BO, Adem BM, Osman MO, Abdulahi ZB, Ibrahim MA. Treatment outcome and 122 associated factors of infantile hypertrophic pyloric stenosis at eastern Ethiopia public hospitals. BMC Surg 2024;24(1):262.
Miyata S, Cho J, Matsushima K, Fowler A, Bliss DW. Operative outcomes of infantile hypertrophic pyloric stenosis in patients with congenital heart disease. J Pediatr Surg 2016;51(11):1755–8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Muhammad Siddique, Muhammad Ramzan, Fawad Mueen Arbi, Soofia Mustafa, Abid Hameed Sheikh, Fayyaz Ahmad
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.
The author(s) retain the copyrights and allow their publication in Pakistan Journal of Physiology, Pak J Physiol, PJP to be FREE for research and academic purposes. It can be downloaded and stored, printed, presented, projected, cited and quoted with full reference of, and acknowledgement to the author(s) and the PJP. The contents are published with an international CC-BY-ND-4.0 License.
