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Lu C, Marcin J, Staab V. Atropine as an Adjunct in the Management of Pediatric Patients With Hypertrophic Pyloric Stenosis: A Single Institution Experience and Review of the Literature. Cureus 2024; 16:e65363. [PMID: 39071076 PMCID: PMC11279068 DOI: 10.7759/cureus.65363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/24/2024] [Indexed: 07/30/2024] Open
Abstract
Infantile hypertrophic pyloric stenosis (IHPS) is a condition whereby there is a thickening of the pyloric muscle, leading to obstruction of the gastric outflow. Typically present within three to five weeks of life, it presents as postprandial non-bilious projectile vomiting. Commonly, a pyloromyotomy is the gold standard to relieve the obstruction. However, in a subset of patients not amenable to undergo surgery or anesthesia, or for postoperative persistent or recurrent obstruction, atropine may offer an alternative treatment. A retrospective review was performed on pediatric patients with hypertrophic pyloric stenosis utilizing the electronic medical record. Data included were demographics, workup data, treatment, outcomes, and symptom resolution. Approval was obtained by the institutional review board of the host institution. Five pediatric patients, with an average age of 2.1 months, received atropine treatment for IHPS. The average time to reach full feeds since the initiation of atropine was approximately four days. Three of the five patients were successfully managed with IV atropine, which was then transitioned to oral atropine and tapered off as outpatients, leading to the resolution of symptoms. The remaining two patients were considered failures of medical management and subsequently required surgery. Atropine use as an alternative treatment for IHPS may be considered when patients are not able to undergo surgery or anesthesia or have recurrent or persistent obstructive symptoms postoperatively. In this limited study, atropine was found to be safe and effective. Randomized controlled studies may lend additional merit to this therapy in the future.
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Affiliation(s)
- Charles Lu
- Department of Pediatric Surgery, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, USA
| | - John Marcin
- Department of Pediatric Surgery, Hackensack Meridian Health School of Medicine, Nutley, USA
| | - Victoriya Staab
- Department of Pediatric Surgery, Hackensack Meridian Health Jersey Shore University Medical Center, Neptune, USA
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Khandelia H, Krishnan N, Kainth D, Verma A, Anand S, Agarwala S. Comparison between umbilical and right upper transverse abdominal incisions for pyloromyotomy: a systematic review and meta-analysis. Pediatr Surg Int 2024; 40:163. [PMID: 38935193 DOI: 10.1007/s00383-024-05747-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/20/2024] [Indexed: 06/28/2024]
Abstract
The aim of this study was to compare the operative parameters and complication rates between the umbilical (UMB) and right upper quadrant (RUQ) skin incisions for Ramstedt's pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis (IHPS). PubMed, EMBASE, Web of Science and Scopus databases were systematically searched. The studies where any one of the main outcomes of interest, i.e., operative time, wound infection rate, mucosal perforation rate were reported were eligible for inclusion. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle-Ottawa Scale. Fifteen studies comprising 2964 infants were included. As compared to the UMB group, the RUQ group showed a significantly lower mean operative time (p = 0.0004), wound infection rate (p < 0.0001) and mucosal perforation rate (p = 0.02). Although UMB incision produces an almost undetectable scar, this approach results in significantly more complications. Therefore, the risks and benefits must be weighed and discussed with the caregivers in deciding the surgical approach in patients with IHPS. However, due to a poor methodological quality of nine out of fifteen studies, further studies need to be conducted for an optimal comparison between the two groups.
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Affiliation(s)
| | - Nellai Krishnan
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Deepika Kainth
- Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Verma
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
| | - Sachit Anand
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India.
| | - Sandeep Agarwala
- Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India
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Ono S, Takenouchi A, Terui K, Yoshida H, Terui E. Risk factors for unsuccessful atropine therapy in hypertrophic pyloric stenosis. Pediatr Int 2019; 61:1151-1154. [PMID: 31520503 DOI: 10.1111/ped.14009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 07/17/2019] [Accepted: 09/10/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND I.v. atropine (IA) for infantile hypertrophic pyloric stenosis (IHPS) is a good alternative to pyloromyotomy but has not been broadly accepted. The lower success rate is one of the greatest disadvantages of IA. We investigated the risk factors for unsuccessful results following IA for IHPS. METHODS Medical records of patients with IHPS who were admitted to Kimitsu Chuo Hospital between 2002 and 2016 and were initially given atropine sulfate were retrospectively reviewed. Atropine was given i.v. (0.1 mg/kg/day in eight divided doses). Oral feeding of milk was started with a small amount and increased in a stepwise fashion to full feed. IA therapy was defined as unsuccessful in the presence of projectile vomiting more than three times a day or intolerance to a predetermined amount of milk. RESULTS Of the 48 patients with IHPS, 33 patients were successfully treated with IA and 15 patients needed surgical intervention. On univariate analysis the risk factors for unsuccessful IA therapy were younger age, lower bodyweight, and shorter duration of symptoms before diagnosis. On multivariate analysis age at diagnosis < 30 days was the only significant risk factor for unsuccessful IA therapy (OR, 5.7 l P = 0.03). CONCLUSIONS Age at diagnosis < 30 days is a risk factor for unsuccessful IA therapy in IHPS. This might be considered when IA therapy is used for neonates with IHPS.
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Affiliation(s)
- Sachie Ono
- Department of Pediatric Surgery, Kimitsu Chuo Hospital, Kisarazu City, Chiba, Japan
| | - Ayako Takenouchi
- Department of Pediatric Surgery, Kimitsu Chuo Hospital, Kisarazu City, Chiba, Japan
| | - Keita Terui
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Hideo Yoshida
- Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba City, Chiba, Japan
| | - Elena Terui
- Department of Pediatric Surgery, Kimitsu Chuo Hospital, Kisarazu City, Chiba, Japan
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Iijima S, Ueno D, Baba T, Ohishi A. Hypertrophic pyloric stenosis following persistent pulmonary hypertension of the newborn: a case report and literature review. BMC Pediatr 2018; 18:290. [PMID: 30176827 PMCID: PMC6122549 DOI: 10.1186/s12887-018-1270-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 08/28/2018] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Although persistent pulmonary hypertension of the newborn (PPHN) and infantile hypertrophic pyloric stenosis (HPS) are both well-known diseases that occur in early infancy, PPHN complicated by HPS is rare. As nitric oxide (NO) is an important mediator of biological functions, on both the vascular endothelium and smooth muscle cells, the decreased production of NO might play a role in the pathogenesis of both PPHN and HPS. We present the case of a neonate who developed HPS following PPHN, including a detailed review on research published to date, and we discuss the pathogenesis of PPHN and HPS. CASE PRESENTATION A female neonate born at 38 weeks of gestation, weighing 3140 g, developed PPHN due to meconium aspiration syndrome. Intensive treatment with high frequency oscillations and inhaled NO were initiated, and sildenafil and bosentan were added. She gradually recovered. At 15 days of age, the patient developed recurrent vomiting after feeding and the diagnosis of HPS was made. Intravenous atropine therapy was started at 20 days of age, but the efficacy was clinically unsatisfactory. The coadministration with transdermal nitroglycerin improved the symptoms, and oral feeding was successfully re-introduced. CONCLUSIONS Our patient recovered from both PPHN and HPS using NO-related medications. A decrease in NO synthesis is likely to be a common pathway for PPHN and HPS.
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Affiliation(s)
- Shigeo Iijima
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 – 20 – 1 Handayama, Hamamatsu, Shizuoka, 431 – 3192 Japan
| | - Daizo Ueno
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 – 20 – 1 Handayama, Hamamatsu, Shizuoka, 431 – 3192 Japan
| | - Toru Baba
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 – 20 – 1 Handayama, Hamamatsu, Shizuoka, 431 – 3192 Japan
| | - Akira Ohishi
- Department of Pediatrics, Hamamatsu University School of Medicine, 1 – 20 – 1 Handayama, Hamamatsu, Shizuoka, 431 – 3192 Japan
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Cubas RF, Longshore S, Rodriguez S, Tagge E, Baerg J, Moores D. Atropine: A Cure for Persistent Post Laparoscopic Pyloromyotomy Emesis? J Neonatal Surg 2017; 6:2. [PMID: 28083488 PMCID: PMC5224753 DOI: 10.21699/jns.v6i1.485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Accepted: 11/06/2016] [Indexed: 11/27/2022] Open
Abstract
Background: Atropine has been used as a successful primary medical treatment for hypertrophic pyloric stenosis. Several authors have reported a higher rate of incomplete pyloromyotomy with the laparoscopic approach compared to open. In this study, we evaluated the use of atropine as a medical treatment for infants with emesis persisting greater than 48 hours after a laparoscopic pyloromyotomy.
Materials and Methods: We performed a retrospective chart review of infants receiving a laparoscopic pyloromyotomy between November 1998 and November 2012. Infants with emesis that persisted beyond 48 hours postoperatively were given 0.01mg/kg of oral atropine 10 minutes prior to feeding. Infants remained inpatient until they tolerated two consecutive feedings without emesis.
Results: 965 patients underwent laparoscopic pyloromyotomy; 816 (84.6%) male and 149 (15.4%) female. Twenty-four (2.5%) received oral atropine. The mean length of stay for patients who received atropine was 5.6 ± 2.6 days, an average of 3 additional days. They were discharged home with a one-month supply of oral atropine. Follow up evaluation did not reveal any complications from receiving atropine. The median follow up was 21 days. None returned to the operating room for incomplete pyloromyotomy. There were 17 (1.8%) operative complications in our series; 9 mucosal perforations, 2 duodenal perforations, and 6 conversions to open for equipment failure or poor exposure. There were 4 (0.4%) post-operative complications: 2 episodes of apnea requiring reintubation and 2 incisional hernias that required a second operation. There were no deaths.
Conclusion: Oral atropine is a viable treatment for persistent emesis after a pyloromyotomy and reduces the need for a second operation due to incomplete pyloromyotomy.
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Affiliation(s)
- Robert Frank Cubas
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Shannon Longshore
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Samuel Rodriguez
- Department of Surgery, Loma Linda University Medical Center, Loma Linda, CA, USA
| | - Edward Tagge
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Joanne Baerg
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
| | - Donald Moores
- Division of Pediatric Surgery, Loma Linda University Children's Hospital, Loma Linda, CA, USA
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Wu SF, Lin HY, Huang FK, Chen AC, Su BH, Li CI, Lin HC. Efficacy of Medical Treatment for Infantile Hypertrophic Pyloric Stenosis: A Meta-analysis. Pediatr Neonatol 2016; 57:515-521. [PMID: 27215474 DOI: 10.1016/j.pedneo.2016.02.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 01/21/2016] [Accepted: 02/21/2016] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Infantile hypertrophic pyloric stenosis (IHPS) is a common disease in infancy. Pyloromyotomy is universally considered the treatment for IHPS; however, oral or intravenous atropine has been reappraised for the treatment of IHPS in the past 20 years. We investigated the efficacy of atropine in the medical management of IHPS by using meta-analysis and investigated the sonographic changes of the pyloric canal, as well as the efficacy and adverse effects of atropine. METHODS Information was retrieved from PubMed, Ovid, and MEDLINE. The efficacy and adverse effects of atropine treatment for IHPS were reviewed using the standard process of meta-analysis. RESULTS Eleven articles were obtained. Five reports showed that 77 of 110 (70%) infants who were administered oral atropine benefitted by the induced remission of IHPS. Six reports showed that 288 of 345 (83.5%) patients who were treated initially with intravenous atropine then changed to oral atropine showed beneficial effects and had no serious side effects. Time to pyloric muscle normalization ranged from 5 weeks to 15 months. CONCLUSION The study results indicate that atropine is a possible alternative treatment for IHPS, particularly in infants with major concurrent disease, and is safe without obvious side effects.
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Affiliation(s)
- Shu-Fen Wu
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Hsiang-Yu Lin
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Fu-Kuei Huang
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan
| | - An-Chyi Chen
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Bai-Horng Su
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Hung-Chih Lin
- Department of Pediatrics, China Medical University Children's Hospital, Taichung, Taiwan; School of Chinese Medicine, China Medical University, Taichung, Taiwan.
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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; 51:1755-1758. [PMID: 27528563 DOI: 10.1016/j.jpedsurg.2016.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/13/2016] [Accepted: 07/02/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE This study aims to compare the outcomes of pyloromyotomy for infantile hypertrophic pyloric stenosis (IHPS) in children with and without congenital heart disease (CHD). METHODS A retrospective, single pediatric center, case-control, matched cohort study was performed over 10years. A case of IHPS with CHD was paired with control patients of IHPS without CHD, matched by age and gender. Perioperative morbidity, 30-day mortality, length of hospital stay, and hospital cost were compared. Subgroups were analyzed based on the severity of CHD and the reason for admission. RESULTS Twenty-six patients who underwent pyloromyotomy for IHPS with CHD (CHD group) were matched with 78 patients with IHPS without CHD (Non-CHD group). No 30-day mortality was identified in either group. Overall perioperative complications were not significantly different between groups (11.5% vs 5.2%, p=0.163). However, postoperative length of stay was longer in CHD group (6 vs 1days, p<0.001) and any subgroups of CHD as compared to Non-CHD group. CHD group patients admitted only for IHPS had short postoperative LOS, whereas those who developed pyloric stenosis during a hospital admission stayed longer postoperatively (1.5 vs 26.5days, p<0.001). Mean hospital costs in patients admitted for IHPS were $16,270 and $3591 for CHD group and Non-CHD group, respectively (p<0.001). CONCLUSIONS IHPS patients with CHD have prolonged postpyloromyotomy course, especially when inpatients with CHD incidentally develop IHPS.
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Affiliation(s)
- Shin Miyata
- Children's Hospital Los Angeles, Los Angeles, California, USA.
| | - Jayun Cho
- LAC+USC Medical Center, Los Angeles, California, USA
| | | | - Aaron Fowler
- Arrowhead Regional Medical Center, Colton, California, USA
| | - David W Bliss
- Children's Hospital Los Angeles, Los Angeles, California, USA
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Fan J, Shi Y, Cheng M, Zhu X, Wang D. Treating idiopathic hypertrophic pyloric stenosis with sequential therapy: A clinical study. J Paediatr Child Health 2016; 52:734-8. [PMID: 27439633 DOI: 10.1111/jpc.13184] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2016] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to explore the efficacy and safety of treating idiopathic hypertrophic pyloric stenosis with sequential therapy (ST). METHODS From January 2010 to June 2013, 49 children with idiopathic hypertrophic pyloric stenosis were divided into two groups to accept either atropine ST (ST group, n = 26) or laparoscopic surgery (operation group, n = 23). The remission rate of vomiting, complications, hospital stay and medical expenditure were compared between the two groups. The body weight and the thickness of the pyloric muscle at 6 months after the treatments were also compared. RESULTS The remission rate of vomiting was lower in the ST group (88.5%; 23/26) than in the operation group (100%, 23/23). The difference in the incidence rate of complications, body weight and pyloric muscle thickness was not statistically significant between the two groups. However, the hospital stay was significantly longer, while the medical expenditure was significantly lower in the ST group than in the operation group. CONCLUSIONS Atropine ST is safe, effective and cost-effective as compared with operation; however, the efficacy of ST is lower than operation.
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Affiliation(s)
- Jianfeng Fan
- Department of Pediatric Surgery, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Yingzuo Shi
- Department of Pediatric Surgery, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Ming Cheng
- Department of Pediatric Surgery, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Xiaomin Zhu
- Department of Pediatric Surgery, Wuxi Children's Hospital, Wuxi, Jiangsu, China
| | - Dafeng Wang
- Department of Pediatric Surgery, Wuxi Children's Hospital, Wuxi, Jiangsu, China
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Almaramhy HH, Alshareif HA. Use of atropine sulfate in the treatment of infantile hypertrophic pyloric stenosis. J Taibah Univ Med Sci 2013. [DOI: 10.1016/j.jtumed.2013.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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10
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Koike Y, Uchida K, Nakazawa M, Inoue M, Kusunoki M, Tsukamoto Y. Predictive factors of negative outcome in initial atropine therapy for infantile hypertrophic pyloric stenosis. Pediatr Int 2013; 55:619-23. [PMID: 23701208 DOI: 10.1111/ped.12137] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/15/2013] [Accepted: 05/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The predictive factors of negative outcome in initial i.v. atropine (IA) therapy of infantile hypertrophic pyloric stenosis (IHPS) are unknown. Conservative therapy for IHPS is useful for infants because it does not have the risk of surgical and anesthetic stress, but some cases of atropine therapy result in failure. This study clarified the predictive markers of negative outcome in initial atropine therapy for IHPS. METHODS Seventy-six patients with IHPS admitted from 1998 to 2011 were included in this study. The predictive risk factors of negative outcome in initial atropine therapy for IHPS were evaluated. RESULTS Thirty-one patients initially underwent non-operative therapy for IHPS during the study period. Of the 31 patients, 18 (58%) ceased projectile vomiting (PV) with IA and subsequent oral atropine. Univariate analysis showed that lack of bodyweight gain before treatment, elevated urine potassium at admission, and PV occurring ≥5 times (PV ≥5) in total for 3 days from IA initiation were predictive risk factors for negative outcome in IHPS. Multivariate analysis identified only PV ≥5 in total for 3 days after IA initiation as independently associated with failure of atropine for IHPS. CONCLUSIONS PV ≥5 in total for 3 days after IA initiation is a potential indicator of negative outcome of IA in IHPS patients. The present results provide valuable information for determining whether early surgical intervention for IHPS or initial atropine therapy is the best option.
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Affiliation(s)
- Yuhki Koike
- Department of Pediatric Surgery, National Mie Hospital, Mie, Japan; Department of Gastrointestinal and Pediatric Surgery, Division of Reparative Medicine, Institute of Life Sciences, Mie University Graduate School of Medicine, Mie, Japan
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Takeuchi M, Yasunaga H, Horiguchi H, Hashimoto H, Matsuda S. Pyloromyotomy versus i.v. atropine therapy for the treatment of infantile pyloric stenosis: nationwide hospital discharge database analysis. Pediatr Int 2013; 55:488-91. [PMID: 23489384 DOI: 10.1111/ped.12100] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 11/03/2012] [Accepted: 02/27/2013] [Indexed: 11/27/2022]
Abstract
BACKGROUND Several studies have suggested that i.v. atropine has a potential role in treating infantile hypertrophic pyloric stenosis (IHPS). It remains unclear, however, whether surgery can be replaced by i.v. therapy. METHODS Data were extracted on infants with IHPS who were treated with atropine and/or surgery, from a nationwide administrative database through 2006-2008. Patient demographic data, treatment effects and length of hospital stay were analyzed in each treatment group. RESULTS A total of 585 infants met the criteria for IHPS; 188 patients (32%) were initially treated with atropine (i.v. form, n = 180; oral form, n = 8), while 397 were treated with surgery as a first-line therapy. Of the 180 infants receiving i.v. atropine, 38 were withdrawn from medical management and subsequently underwent surgery. Thus, the overall success rate of i.v. atropine was 78.9% (142/180). Surgery had a success rate of 100%, and postoperative complications were found in 2.8% of patients (12/435). Medical management required longer hospital stay than surgery (mean, 13.5 days vs 8.0 days; P < 0.001). CONCLUSION Surgery remains the suitable standard management option for IHPS, with its high success rate, minimal complications and shorter hospital stay compared with i.v. atropine therapy.
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Affiliation(s)
- Masato Takeuchi
- Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan.
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12
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Mercer AE, Phillips R. Question 2: can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to surgical pyloromyotomy? Arch Dis Child 2013; 98:474-7. [PMID: 23661669 DOI: 10.1136/archdischild-2013-303655] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- Anita Erika Mercer
- The Hull York Medical School, John Hughlings Jackson Building, University of York, York YO10 5DD, UK.
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13
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Owen RP, Almond SL, Humphrey GME. Atropine sulphate: rescue therapy for pyloric stenosis. BMJ Case Rep 2012; 2012:bcr2012006489. [PMID: 22865807 PMCID: PMC4544211 DOI: 10.1136/bcr-2012-006489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Infantile hypertrophic pyloric stenosis (IHPS) is a common condition which presents with non-bilious vomiting and failure to thrive secondary to gastric outlet obstruction. In the UK, management is by fluid resuscitation followed by pyloromyotomy. Incomplete myotomy complicates 0.3% of cases necessitating further surgery and exposing the patient to further risk. Medical management of IHPS with antimuscarinics to promote pyloric relaxation is a well-described treatment modality that is used as first-line therapy in some countries. The use of this technique is limited by the need for extended hospital admission with parenteral nutrition administration. We describe a case of IHPS complicated by incomplete pyloromyotomy and subsequently managed successfully by atropine sulphate therapy.
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14
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Ranells JD, Carver JD, Kirby RS. Infantile hypertrophic pyloric stenosis: epidemiology, genetics, and clinical update. Adv Pediatr 2011; 58:195-206. [PMID: 21736982 DOI: 10.1016/j.yapd.2011.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Judith D Ranells
- Department of Pediatrics, College of Medicine, University of South Florida, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612, USA
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15
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Rapoport A. Sublingual atropine drops for the treatment of pediatric sialorrhea. J Pain Symptom Manage 2010; 40:783-8. [PMID: 20541902 DOI: 10.1016/j.jpainsymman.2010.02.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 02/19/2010] [Accepted: 02/22/2010] [Indexed: 10/19/2022]
Abstract
Excess oral secretions or sialorrhea is a common problem affecting children and adults with neurological disorders, as well as those approaching the end of life because of a variety of underlying illnesses. Systemic anticholinergic medications are often prescribed in an attempt to improve quality of life and reduce complications; yet, response rates are variable, and a sizable proportion of patients discontinue these drugs as a result of intolerable side effects. This report describes the successful use of a local treatment, sublingually delivered ophthalmic atropine drops, to reduce sialorrhea in a child receiving palliative care. In addition, medical evidence for the safety and efficacy of traditionally prescribed systemic medications for the treatment of pediatric sialorrhea is reviewed.
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Affiliation(s)
- Adam Rapoport
- Max and Beatrice Wolfe Children's Centre, Temmy Latner Centre for Palliative Care, Mount Sinai Hospital, and Division of Pediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada.
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Wang J, Waller DK, Hwang LY, Taylor LG, Canfield MA. Prevalence of infantile hypertrophic pyloric stenosis in Texas, 1999-2002. ACTA ACUST UNITED AC 2008; 82:763-7. [DOI: 10.1002/bdra.20527] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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17
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Aldridge RD, MacKinlay GA, Aldridge RB. Choice of Incision: The Experience And Evolution of Surgical Management of Infantile Hypertrophic Pyloric Stenosis. J Laparoendosc Adv Surg Tech A 2007; 17:131-6. [PMID: 17362191 DOI: 10.1089/lap.2006.0525] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE This study evaluated the impact of laparoscopic pyloromyotomy since it came into use at our institution in March 1999. MATERIALS AND METHODS The recovery profiles and intraoperative and postoperative complications of 170 infants who underwent laparoscopic, semicircumumbilical incision, or right upper quadrant incision pyloromyotomies between March 1999 and April 2005 were analyzed. RESULTS Eighty-one (48%) of operations were undertaken laparoscopically, 51 (30%) by traditional right upper quadrant incision, and 38 (22%) by semicircumumbilical incision. Patient group demographics were similar across all groups. There was no significant difference in overall complication rate between procedures: laparoscopic group, 12.3% (10/81); semicircumumbilical incision group, 18.4% (7/38); and right upper quadrant incision group, 9.8% (5/51). Early in the laparoscopic series there were 2 inadequate pyloromyotomies and 2 conversions to open procedures due to perforation (n = 1) and poor visibility (n = 1). Infections were more common with open surgery: laparoscopic, 1.2% (n = 1), right upper quadrant incision, 7.8% (n = 4), and semicircumumbilical incision, 13.2% (n = 5). Operative correction was required for herniation at 3 laparoscopic incision sites (3.6%), 2 semicircumumbilical incision sites (5.3%), and 2 right upper quadrant incision sites (3.9%). Patients who underwent laparoscopy returned to full feeds faster (laparoscopic, 18.1 hours; right upper quadrant incision, 28.1 hours; and semicircumumbilical incision, 28.9 hours) (P < 0.05), required less analgesia (laparoscopic, 2.1 doses; right upper quadrant incision, 4.0 doses; and semicircumumbilical incision, 4.3 doses) (P < 0.05), and had less emesis (laparoscopic, 1.6 episodes; right upper quadrant incision, 2.9 episodes; and semicircumumbilical incision, 3.5 episodes) (P < 0.05), resulting in faster discharge (laparoscopic, 2.0 days; right upper quadrant incision, 3.1 days; and semicircumumbilical incision, 3.2 days) (P < 0.05). CONCLUSION Laparoscopic pyloromytomy is as effective and safe as open procedures and is associated with an improved recovery profile. We conclude that, where laparoscopic skills exist, laparoscopy should be the management of choice for hypertrophic pyloric stenosis.
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Affiliation(s)
- Roderick D Aldridge
- Department of Surgery, Royal Hospital for Sick Children, Edinburgh, United Kingdom
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