The use of pyloric traumamyoplasty in cases of infantile hypertrophic pyloric stenosis

الملخص EN

Background : Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical pathology with an unknown etiology in children.

The prevalence of IHPS ranges from 1.

5 to 4.

0 in 1000 live births among whites but is less prevalent in African Americans and Asians.

In spite of the high frequency of this condition, there is no general agreement about the best surgical technique for the treatment of IHPS.

The routine operation has been Ramstedt pyloromyotomy with cutting of the hypertrophied pyloric muscle.

The technique of traumamyoplasty was introduced as a way to overcome the technical difficulties associated with pyloromyotomies especially when using the transumbilical and laparoscopic approaches.

Aims : To study the role and efficacy of pyloric traumamyoplasty in cases done either through the transumbilical or the laparoscopic approach.

To compare between the two approaches regarding the mean operative time, the post operative emesis and, mean post operative hospital stay.

Methods : 40 infants with IHPS were included in this study, all of them operated upon using the pyloric traumamyoplasty technique, of whom 20 were operated upon using the transumbilical approach and the other 20 using the laparoscopic approach.

Results: The mean operative time for transumbilical pyloric traumamyoplasty was 21 minutes and for the laparoscopic traumamyoplasty was 18 minutes.

Post operative emesis: occurred in 6 cases (15 %) done by the transumbilical approach.

and 7 cases (18 %) by the laparoscopic approach.

Post operative hospitalization time varied from 2 to 5 days.

Statistical analysis showed no significant difference in these variants.

There was no complication noted in this study either during surgery or in the postoperative period.

Conclusion: Ricardo et al, on their series of traumamyoplasty for the surgical treatment of IHPS, they reported decreased .incidence of intra-operative complications especially mucosal perforation or incomplete pyloromyotomy.

Pyloromyotomy using the umbilical approach has a potential higher rate of mucosal perforation or inadequate pyloromyotomies owing to the increased difficulty to deliver the pylorus through the umbilical incision.

This is avoided during traumamyoplasty as delivery of the mass is not required to complete the procedure.