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Eur J Pediatr Surg 2018; 28(02): 171-175
DOI: 10.1055/s-0038-1637016
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Perioperative Complications of Surgery for Hypertrophic Pyloric Stenosis

Arun Kelay
1   Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom
,
Nigel J. Hall
1   Department of Paediatric Surgery and Urology, Southampton Children's Hospital, Southampton, United Kingdom
2   University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
› Author Affiliations
Further Information

Publication History

05 February 2018

12 February 2018

Publication Date:
06 March 2018 (online)

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Abstract

Pyloromyotomy is the tried and tested surgical procedure for successful operative treatment of pyloric stenosis. Over time, the operative approach has evolved to take advantage of cosmetically superior incisions and more recently minimally invasive surgery. During and following surgery, complications are uncommon. The specific complications of an inadequate pyloromyotomy requiring repeated procedure and mucosal perforation during an overzealous pyloromyotomy represent the ends of a spectrum within which sits the perfect procedure. Here, we discuss these specific complications together with the other potential complications following surgery for hypertrophic pyloric stenosis, including anesthetic considerations.

Keywords

pyloric stenosis - pyloromyotomy - surgical complications
 

  • References

  • 1 Rammstedt C. Zur Operation der Angeborenen Pylorusstenose. Med Klin 1912; 8: 1702-1706
    PubMedGoogle Scholar
  • 2 Dufour H, Fredet P. La Stenose Hypertrophique Du Pylore chez le Nourrisson et son Traitement Chirurgical. Bull Mem Soc Med Paris 1907; 24: 1221
    PubMedGoogle Scholar
  • 3 Tan KC, Bianchi A. Circumumbilical incision for pyloromyotomy. Br J Surg 1986; 73 (05) 399
    CrossrefPubMedGoogle Scholar
  • 4 Alain JL, Grousseau D, Terrier G. Extramucosal pyloromyotomy by laparoscopy. Surg Endosc 1991; 5 (04) 174-175
    CrossrefPubMedGoogle Scholar
  • 5 St Peter SD, Holcomb III GW, Calkins CM. , et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial. Ann Surg 2006; 244 (03) 363-370
    Google Scholar
  • 6 Siddiqui S, Heidel RE, Angel CA, Kennedy Jr AP. Pyloromyotomy: randomized control trial of laparoscopic vs open technique. J Pediatr Surg 2012; 47 (01) 93-98
    CrossrefPubMedGoogle Scholar
  • 7 Leclair MD, Plattner V, Mirallie E. , et al. Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a prospective, randomized controlled trial. J Pediatr Surg 2007; 42 (04) 692-698
    CrossrefPubMedGoogle Scholar
  • 8 Marks IH, Chang DC, Masiakos PT, Kelleher CM. Is all-cause readmission an appropriate performance measure for pediatric surgeons? A case study in pyloromyotomy. J Pediatr Surg 2017; 52 (09) 1426-1429
    CrossrefPubMedGoogle Scholar
  • 9 Safford SD, Pietrobon R, Safford KM, Martins H, Skinner MA, Rice HE. A study of 11,003 patients with hypertrophic pyloric stenosis and the association between surgeon and hospital volume and outcomes. J Pediatr Surg 2005; 40 (06) 967-972
    CrossrefPubMedGoogle Scholar
  • 10 Katz MS, Schwartz MZ, Moront ML, Arthur III LG, Timmapuri SJ, Prasad R. Prophylactic antibiotics do not decrease the incidence of wound infections after laparoscopic pyloromyotomy. J Pediatr Surg 2011; 46 (06) 1086-1088
    CrossrefPubMedGoogle Scholar
  • 11 Ein SH, Masiakos PT, Ein A. The ins and outs of pyloromyotomy: what we have learned in 35 years. Pediatr Surg Int 2014; 30 (05) 467-480
    CrossrefPubMedGoogle Scholar
  • 12 Sola JE, Neville HL. Laparoscopic vs open pyloromyotomy: a systematic review and meta-analysis. J Pediatr Surg 2009; 44 (08) 1631-1637
    CrossrefPubMedGoogle Scholar
  • 13 van den Ende ED, Allema JH, Hazebroek FW, Breslau PJ. Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital? Results from two teaching hospitals. Eur J Pediatr 2007; 166 (06) 553-557
    CrossrefPubMedGoogle Scholar
  • 14 Podevin G, Missirlu A, Branchereau S, Audry G, Gruner M. Umbilical incision for pyloromyotomy. Eur J Pediatr Surg 1997; 7 (01) 8-10
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Keys C, Johnson C, Teague W, MacKinlay G. One hundred years of pyloric stenosis in the Royal Hospital for Sick Children Edinburgh. J Pediatr Surg 2015; 50 (02) 280-284
    CrossrefPubMedGoogle Scholar
  • 16 Mullassery D, Pedersen A, Robb A, Smith N. Incisional hernia in pediatric surgery - experience at a single UK tertiary centre. J Pediatr Surg 2016; 51 (11) 1791-1794
    CrossrefPubMedGoogle Scholar
  • 17 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 (03) 325-333
    CrossrefPubMedGoogle Scholar
  • 18 Hall NJ, Eaton S, Seims A. , et al. Risk of incomplete pyloromyotomy and mucosal perforation in open and laparoscopic pyloromyotomy. J Pediatr Surg 2014; 49 (07) 1083-1086
    CrossrefPubMedGoogle Scholar
  • 19 Ostlie DJ, Woodall CE, Wade KR. , et al. An effective pyloromyotomy length in infants undergoing laparoscopic pyloromyotomy. Surgery 2004; 136 (04) 827-832
    CrossrefPubMedGoogle Scholar
  • 20 Shaw RB. Simple technique for assuring completeness of a pyloromyotomy. J Am Coll Surg 1994; 178 (03) 303-304
    PubMedGoogle Scholar
  • 21 Khoshoo V, Noel RA, LaGarde D, Buras F, Gilger MA. Endoscopic balloon dilatation of failed pyloromyotomy in young infants. J Pediatr Gastroenterol Nutr 1996; 23 (04) 447-451
    CrossrefPubMedGoogle Scholar
  • 22 Owen RP, Almond SL, Humphrey GM. Atrophine sulphate: rescue therapy for pyloric stenosis. BMJ Case Rep 2012; 2012 : pii: bcr201200648
    Google Scholar
  • 23 Kawahara H, Takama Y, Yoshida H. , et al. Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the “olive”?. J Pediatr Surg 2005; 40 (12) 1848-1851
    CrossrefPubMedGoogle Scholar
  • 24 Tam PKH, Carty H. Endoscopy-guided balloon dilatation for infantile hypertrophic pyloric stenosis. Pediatr Surg Int 1991; 6 (4–5): 306-308
    PubMedGoogle Scholar
  • 25 Eke N. Postoperative tension pneumoperitoneum in an infant. Pediatr Surg Int 2001; 17 (2-3): 204-205
    CrossrefPubMedGoogle Scholar
  • 26 Royal RE, Linz DN, Gruppo DL, Ziegler MM. Repair of mucosal perforation during pyloromyotomy: surgeon's choice. J Pediatr Surg 1995; 30 (10) 1430-1432
    CrossrefPubMedGoogle Scholar
  • 27 Jia WQ, Tian JH, Yang KH. , et al. Open versus laparoscopic pyloromyotomy for pyloric stenosis: a meta-analysis of randomized controlled trials. Eur J Pediatr Surg 2011; 21 (02) 77-81
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Waldron LS, St Peter SD, Muensterer OJ. Management and outcome of mucosal injury during pyloromyotomy--an analytical survey study. J Laparoendosc Adv Surg Tech A 2015; 25 (12) 1044-1046
    CrossrefPubMedGoogle Scholar
  • 29 Kamata M, Cartabuke RS, Tobias JD. Perioperative care of infants with pyloric stenosis. Paediatr Anaesth 2015; 25 (12) 1193-1206
    CrossrefPubMedGoogle Scholar
  • 30 Bissonnette B, Sullivan PJ. Pyloric stenosis. Can J Anaesth 1991; 38 (05) 668-676
    CrossrefPubMedGoogle Scholar
  • 31 Cook-Sather SD, Tulloch HV, Liacouras CA, Schreiner MS. Gastric fluid volume in infants for pyloromyotomy. Can J Anaesth 1997; 44 (03) 278-283
    CrossrefPubMedGoogle Scholar
  • 32 Ankermann T, Engler S, Partsch CJ. Repyloromyotomy for recurrent infantile hypertrophic pyloric stenosis after successful first pyloromyotomy. J Pediatr Surg 2002; 37 (11) E40
    CrossrefPubMedGoogle Scholar
  • 33 Nasr A, Ein SH, Connolly B. Recurrent pyloric stenosis: to dilate or operate? A preliminary report. J Pediatr Surg 2008; 43 (02) e17-e20
    PubMedGoogle Scholar
  • 34 Markel TA, Scott MR, Stokes SM, Ladd AP. A randomized trial to assess advancement of enteral feedings following surgery for hypertrophic pyloric stenosis. J Pediatr Surg 2017; 52 (04) 534-539
    CrossrefPubMedGoogle Scholar
  • 35 St Peter SD, Tsao K, Sharp SW, Holcomb III GW, Ostlie DJ. Predictors of emesis and time to goal intake after pyloromyotomy: analysis from a prospective trial. J Pediatr Surg 2008; 43 (11) 2038-2041
    CrossrefPubMedGoogle Scholar
  • 36 Adibe OO, Nichol PF, Lim FY, Mattei P. Ad libitum feeds after laparoscopic pyloromyotomy: a retrospective comparison with a standardized feeding regimen in 227 infants. J Laparoendosc Adv Surg Tech A 2007; 17 (02) 235-237
    CrossrefPubMedGoogle Scholar
  • 37 Sullivan KJ, Chan E, Vincent J, Iqbal M, Wayne C, Nasr A. ; Canadian Association of Paediatric Surgeons Evidence-Based Resource. Feeding post-pyloromyotomy: a meta-analysis. Pediatrics 2016;137(1)
    PubMedGoogle Scholar
  • 38 Hall NJ, Pacilli M, Eaton S. , et al. Recovery after open versus laparoscopic pyloromyotomy for pyloric stenosis: a double-blind multicentre randomised controlled trial. Lancet 2009; 373 (9661): 390-398
    CrossrefPubMedGoogle Scholar
  • 39 Mullassery D, Mallappa S, Shariff R. , et al. Negative exploration for pyloric stenosis--is it preventable?. BMC Pediatr 2008; 8: 37
    CrossrefPubMedGoogle Scholar