Results of a Five Year Survey of 351 Cases of Hypertrophic Pyloric Stenosis in Kyushu, Japan

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  • 肥厚性幽門狭窄症 351 例の検討 : 第 28 回九州小児外科研究会アンケート調査報告

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Purpose : The aim of this study was to evaluate recent trends in the epidemiology, diagnosis and treatment of hypertrophic pyloric stenosis (HPS). Methods : Three hundred fifty-one cases of HPS presenting during the five-year period between 1993 and 1997 were reviewed using a questionnaire and the results presented at the 28th Kyushu Pediatric Surgery Study Meeting. Results : Information on 351 infants with HPS was collected from 24 medical institutions. The male to female ratio was 4 : 1 and 51.9% of all cases were firstborn infants. The mean birth weight was 3113 g. The incidence of a family history of HPS was 2.6% and the incidence of associated anomalies or lesions was 7.0%. The age at onset of symptoms was within the first two months of life in 94.5% of cases. Ultrasonography was performed in 92.0% of cases as a diagnostic tool, and a pyloric mass was palpable in 70.7% of cases. An upper Gl series was performed in only 25.9% of cases. The mean levels of serum Cl and base excess on admission were 98.8 mEq/l and +3.9 mEq/l respectively. Ramstedt's procedure through an upper abdominal transverse incision was generally performed, but transumbilical pyloromyotomy or laparoscopic pyloromyotomy were performed in a small number of cases. Mucosal perforation during surgery was encountered in 4.7% of cases, and frequent postoperative vomiting was seen in 4.2% of cases. Reoperation was necessary in three infants. Medical treatiment for HPS using intravenous atropine sulfate was successful in some cases. Conclusions : Since the incidence of severely dehydrated and malnourished infants with HPS has decreased markedly in recent years, ultrasonography is the most reliable tool for the diagnosis of HPS. However, the importance of palpating a pyloric mass is still important as a diagnostic sign. For treating HPS, transumbilical pyloromyotomy, laparoscopic pyloromyotomy, and non-surgical management with intravenous atropine sulfate have become available as alternatives to the standard Ramstedt's procedure through an upper abdominal transverse incision.

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