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The Journal of Surgical Research Jun 2022Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Infantile hypertrophic pyloric stenosis is treated by either open pyloromyotomy (OP) or laparoscopic pyloromyotomy (LP). The aim of this meta-analysis was to compare the open versus laparoscopic technique.
METHODS
A literature search was conducted from 1990 to February 2021 using the electronic databases MEDLINE, Embase, and Cochrane Central Register of Controlled Trials. Primary outcomes were mucosal perforation and incomplete pyloromyotomy. Secondary outcomes consisted of length of hospital stay, time to full feeds, operating time, postoperative wound infection/abscess, incisional hernia, hematoma/seroma formation, and death.
RESULTS
Seven randomized controlled trials including 720 patients (357 with OP and 363 with LP) were included. Mucosal perforation rate was not different between groups (relative risk [RR] LP versus OP 1.60 [0.49-5.26]). LP was associated with nonsignificant higher risk of incomplete pyloromyotomy (RR 7.37 [0.92-59.11]). There was no difference in neither postoperative wound infections after LP compared with OP (RR 0.59 [0.24-1.45]) nor in postoperative seroma/hematoma formation (RR 3.44 [0.39-30.43]) or occurrence of incisional hernias (RR 1.01 [0.11-9.53]). Length of hospital stay (-3.01 h for LP [-8.39 to 2.37 h]) and time to full feeds (-5.86 h for LP [-15.95 to 4.24 h]) were nonsignificantly shorter after LP. Operation time was almost identical between groups (+0.53 min for LP [-3.53 to 4.59 min]).
CONCLUSIONS
On a meta-level, there is no precise effect estimate indicating that LP carries a higher risk for mucosal perforation or incomplete pyloromyotomies compared with the open equivalent. Because of very low certainty of evidence, we do not know about the effect of the laparoscopic approach on postoperative wound infections, postoperative hematoma or seroma formation, incisional hernia occurrence, length of postoperative stay, time to full feeds, or operating time.
Topics: Abscess; Hematoma; Humans; Incisional Hernia; Infant; Laparoscopy; Pyloric Stenosis, Hypertrophic; Pyloromyotomy; Pylorus; Seroma; Surgical Wound Infection
PubMed: 35104694
DOI: 10.1016/j.jss.2021.12.042 -
Asian Journal of Surgery Sep 2022Infantile hypertrophic pyloric stenosis (IHPS) is the most common condition requiring surgery in infancy, but the etiology of IHPS is still unclear. The study aimed to...
BACKGROUND
Infantile hypertrophic pyloric stenosis (IHPS) is the most common condition requiring surgery in infancy, but the etiology of IHPS is still unclear. The study aimed to analyze the epidemiological and clinical features of the infants with IHPS in our setting and determine the yearly trends in IHPS incidence in the Sarajevo Canton between 2007 and 2016.
METHODS
We retrospectively analyzed epidemiologic, clinical, and operative data of all infants undergoing pyloromyotomy for IHPS over ten years in the largest tertiary care facility in Bosnia and Herzegovina.
RESULTS
Fifty-three IHPS patients were diagnosed, yielding an overall incidence of 1.17 per 1000 live births (1.25 and 1.09 cases in 2007-2011 and 2012-2016, respectively). IHPS was more prevalent among male infants (ratio 6.6:1, p < 0.001). The mean age at onset of symptoms was 39.6 days (range, 17-107 days). The estimated median time from symptoms onset to hospitalization was 11 days (range, 1-17 days). The mean age at diagnosis was significantly longer in premature infants compared with term infants (p = 0.003). Both first-born rank and bottle-feeding were significantly associated with IHPS (p = 0.001 and p = 0.04, respectively). No seasonal variation associated with IHPS was detected (p = 0.25). No evidence was found of differences in the incidence of IHPS related to maternal age (p = 0.24) and smoking (p = 0.59).
CONCLUSION
Our data indicate a declining trend and provide insights into the clinical characteristics of IHPS in Bosnia and Herzegovina. Most of the obtained results are in line with the published data and could improve the quality of local pediatric services.
Topics: Bosnia and Herzegovina; Child; Humans; Infant; Male; Pyloric Stenosis, Hypertrophic; Pyloromyotomy; Retrospective Studies; Tertiary Healthcare
PubMed: 34801371
DOI: 10.1016/j.asjsur.2021.10.012 -
Pediatric Surgery International Jan 2018Despite hypertrophic pyloric stenosis (HPS) being one of the most frequently treated pediatric surgical conditions, its etiology remains incompletely understood. We... (Review)
Review
Despite hypertrophic pyloric stenosis (HPS) being one of the most frequently treated pediatric surgical conditions, its etiology remains incompletely understood. We review the diagnosis and treatment of this condition with an emphasis on the evolution of surgical techniques that led to laparoscopic pyloromyotomy, the most frequently performed technique for HPS today. In addition, we review key developments in the understanding of HPS etiology and treatment, including the postulated etiology of work-induced hypertrophy of the pylorus, its association with prokinetic macrolide antibiotics, and the emerging role of atropine sulfate as a medical treatment for HPS or a rescue treatment for incomplete myotomy.
Topics: Atropine; History, 19th Century; History, 20th Century; Humans; Intraoperative Complications; Laparoscopy; Parasympatholytics; Postoperative Care; Postoperative Complications; Preoperative Care; Pyloric Stenosis, Hypertrophic; Pyloromyotomy
PubMed: 29030700
DOI: 10.1007/s00383-017-4196-y -
Journal of Pediatric Surgery Sep 2022
Topics: Humans; Infant; Infant, Newborn; Pyloric Stenosis, Hypertrophic
PubMed: 35487797
DOI: 10.1016/j.jpedsurg.2022.03.012 -
International Journal of Colorectal... May 2023To assess the safety and efficacy of single-incision versus conventional laparoscopic pyloromyotomy in pediatrics, we conducted a systematic review and meta-analysis. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To assess the safety and efficacy of single-incision versus conventional laparoscopic pyloromyotomy in pediatrics, we conducted a systematic review and meta-analysis.
METHODS
A literature search was conducted to identify studies that compared single-incision laparoscopic pyloromyotomy (SILP) and conventional laparoscopic pyloromyotomy (CLP) for infants with hypertrophic pyloric stenosis (HPS). Meta-analysis was used to pool and compare variables such as operative time, time to full feeding, length of hospital stay, mucosal perforation, inadequate pyloromyotomy, wound infection, incisional hernia and overall complications.
RESULTS
Among the 490 infants with HPS in the seven studies, 205 received SILP and 285 received CLP. There was significant longer time to full feeding for SILP compared with CLP. However, pooling the results for SILP and CLP revealed no significant difference in operative time, length of hospital stay and postoperative complications.
CONCLUSIONS
SILP is a safe, feasible and effective surgical procedure for infants with HPS when compared to CLP. SILP is equivalent to CLP in terms of operative time, length of hospital stay and postoperative complications. We conclude that LS should be considered an acceptable option for HPS.
Topics: Infant; Humans; Child; Pyloric Stenosis, Hypertrophic; Pyloromyotomy; Laparoscopy; Postoperative Complications; Incisional Hernia; Pylorus; Retrospective Studies
PubMed: 37154949
DOI: 10.1007/s00384-023-04402-z -
Journal of Pediatric Surgery Oct 2021Infantile hypertrophic pyloric stenosis (IHPS) is a complex disorder with an incidence from 4 to 5 per 1000 live births with a strongly male predilection. The natural... (Review)
Review
Infantile hypertrophic pyloric stenosis (IHPS) is a complex disorder with an incidence from 4 to 5 per 1000 live births with a strongly male predilection. The natural history of this initially fatal condition with nearly 100% mortality has evolved to a disease with a good prognosis. Pyloromyotomy by Ramstedt was first described 110 years ago and still remains the standard of surgical treatment for patients with IHPS. The laparoscopic approach is becoming more common and is the preferred method of treatment now in many centres.
Topics: Humans; Infant; Male; Pyloric Stenosis, Hypertrophic; Pyloromyotomy
PubMed: 34172284
DOI: 10.1016/j.jpedsurg.2021.05.009 -
Journal of Paediatrics and Child Health Oct 2019To evaluate the trend in presentation and postoperative outcomes of infants with hypertrophic pyloric stenosis (HPS) over the last decade.
AIM
To evaluate the trend in presentation and postoperative outcomes of infants with hypertrophic pyloric stenosis (HPS) over the last decade.
METHODS
This was a multicentre retrospective study in two tertiary paediatric centres between 2005 and 2015 inclusive. Participants included 626 infants who underwent a pyloromyotomy for HPS. We collected data on presentation features (age, weight, clinical signs, blood gas results, ultrasound findings) and postoperative outcomes (length of stay (LOS), complications, time to first postoperative feed).
RESULTS
No trend was identified during the study period with regards to age, weight, biochemical findings (pH, chloride, base excess) or pre-operative ultrasound measurements. There was a downtrend in the number of palpated tumours over time, with a mean of 36% of tumours clinically palpated. Pyloric wall thickness had a moderate association with LOS in patients admitted for >8 days (correlation = 0.4752) but had a weak negative association with shorter lengths of stay (≤8 day, correlation = -0.094). Overall, median time to first feed was 7.80 h and improved yearly during the study period (hazard ratio = 1.07).
CONCLUSIONS
Patients presenting with HPS are not being identified at an earlier age or with fewer biochemical derangements, in contrast to our initial perceptions. Subsequently, biochemical derangements can still play an important role in the diagnosis of HPS, and attention needs to be given to fluid management and electrolyte correction in all patients with HPS.
Topics: Hospitals, Pediatric; Humans; Infant; Infant, Newborn; Outcome Assessment, Health Care; Poisson Distribution; Pyloric Stenosis, Hypertrophic; Retrospective Studies
PubMed: 30677197
DOI: 10.1111/jpc.14372 -
Pediatrics Jan 2016Postoperative emesis is common after pyloromyotomy. Although postoperative feeding is likely to be an influencing factor, there is no consensus on optimal feeding. (Meta-Analysis)
Meta-Analysis Review
CONTEXT
Postoperative emesis is common after pyloromyotomy. Although postoperative feeding is likely to be an influencing factor, there is no consensus on optimal feeding.
OBJECTIVE
To compare the effect of feeding regimens on clinical outcomes of infants after pyloromyotomy.
DATA SOURCES
Cumulative Index to Nursing and Allied Health Literature, The Cochrane Central Register of Controlled Trials, Embase, and Medline.
STUDY SELECTION
Two reviewers independently assessed studies for inclusion based on a priori inclusion criteria.
DATA EXTRACTION
Data were extracted on methodological quality, general study and intervention characteristics, and clinical outcomes.
RESULTS
Fourteen studies were included. Ad libitum feeding was associated with significantly shorter length of stay (LOS) when compared with structured feeding (mean difference [MD] -4.66; 95% confidence interval [CI], -8.38 to -0.95; P = .01). Although gradual feeding significantly decreased emesis episodes (MD -1.70; 95% CI, -2.17 to -1.23; P < .00001), rapid feeding led to significantly shorter LOS (MD 22.05; 95% CI, 2.18 to 41.93; P = .03). Late feeding resulted in a significant decrease in number of patients with emesis (odds ratio 3.13; 95% CI, 2.26 to 4.35; P < .00001).
LIMITATIONS
Exclusion of non-English studies, lack of randomized controlled trials, insufficient number of studies to perform publication bias or subgroup analysis for potential predictors of emesis.
CONCLUSIONS
Ad libitum feeding is recommended for patients after pyloromyotomy as it leads to decreased LOS. If physicians still prefer structured feeding, early rapid feeds are recommended as they should lead to a reduced LOS.
Topics: Digestive System Surgical Procedures; Feeding Methods; Humans; Infant; Postoperative Care; Pyloric Stenosis, Hypertrophic; Pylorus
PubMed: 26719292
DOI: 10.1542/peds.2015-2550 -
European Journal of Pediatrics Mar 2019Macrolides are bacteriostatic antibiotics with a broad spectrum of activity against Gram-positive bacteria. The aim of this study was to systematically review and... (Meta-Analysis)
Meta-Analysis Review
Macrolides are bacteriostatic antibiotics with a broad spectrum of activity against Gram-positive bacteria. The aim of this study was to systematically review and meta-analyze the association between infantile hypertrophic pyloric stenosis (IHPS) and macrolides. Nine databases were searched systematically for studies with information on the association between macrolides and IHPS. We combined findings using random effects models. Our study revealed 18 articles investigating the association between macrolides and IHPS. There was a significant association between the development of IHPS and erythromycin (2.38, 1.06-5.39). The association was strong when erythromycin was used during the first 2 weeks of life (8.14, 4.29-15.45). During breastfeeding, use of macrolides showed no significant association with IHPS in infants (0.96, 0.61-1.53). IHPS was not associated with erythromycin (1.11, 0.9-1.36) or macrolides use during pregnancy (1.15, 0.98-1.36).Conclusions: There is an association between erythromycin use during infancy and developing IHPS in infants. However, no significant association was found between macrolides use during pregnancy or breastfeeding. Additional large studies are needed to further evaluate potential association with macrolide use. What is known? • Erythromycin intake in the first 2 weeks of life is associated with an increased risk of pyloric stenosis. What is New? • There is currently no evidence of significant association between macrolides use during pregnancy or breastfeeding and pyloric stenosis.
Topics: Anti-Bacterial Agents; Breast Feeding; Female; Humans; Infant; Infant, Newborn; Macrolides; Pregnancy; Prenatal Exposure Delayed Effects; Pyloric Stenosis, Hypertrophic; Risk Factors
PubMed: 30470884
DOI: 10.1007/s00431-018-3287-7 -
European Journal of Pediatric Surgery :... Dec 2023Normalization of metabolic alkalosis is an important pillar in the treatment of infantile hypertrophic pyloric stenosis (IHPS) because uncorrected metabolic alkalosis...
BACKGROUND
Normalization of metabolic alkalosis is an important pillar in the treatment of infantile hypertrophic pyloric stenosis (IHPS) because uncorrected metabolic alkalosis may lead to perioperative respiratory events. However, the evidence on the incidence of respiratory events is limited. We aimed to study the incidence of peroperative hypoxemia and postoperative respiratory events in infants undergoing pyloromyotomy and the potential role of metabolic alkalosis.
MATERIALS AND METHODS
We retrospectively reviewed all patients undergoing pyloromyotomy between 2007 and 2017. All infants received intravenous fluids preoperatively to correct metabolic abnormalities close to normal. We assessed the incidence of perioperative hypoxemia (defined as oxygen saturation [SpO] < 90% for > 1min) and postoperative respiratory events. Additionally, the incidence of difficult intubations was evaluated. We performed a multivariate logistic regression analysis to evaluate the association between admission or preoperative serum pH values, bicarbonate or chloride, and peri- and postoperative hypoxemia or respiratory events.
RESULTS
Of 406 included infants, 208 (51%) developed 1 or more episodes of hypoxemia during the perioperative period, of whom 130 (32%) experienced it during induction, 43 (11%) intraoperatively, and 112 (28%) during emergence. About 7.5% of the infants had a difficult intubation and 17 required more than 3 attempts by a pediatric anesthesiologist. Three patients developed respiratory insufficiency and 95 postoperative respiratory events were noticed. We did not find a clinically meaningful association between laboratory values reflecting metabolic alkalosis and respiratory events.
CONCLUSIONS
IHPS frequently leads to peri- and postoperative hypoxemia or respiratory events and high incidence of difficult tracheal intubations. Preoperative pH, bicarbonate, and chloride were bad predictors of respiratory events.
Topics: Infant; Humans; Child; Pyloric Stenosis, Hypertrophic; Retrospective Studies; Bicarbonates; Chlorides; Hypoxia; Alkalosis
PubMed: 36417975
DOI: 10.1055/a-1984-9803