Infantile hypertrophic pyloric stenosis: A comparative study of pyloric traumamyoplasty and Fredet-Ramstedt pyloromyotomy☆

Abstract 

Purpose: The aim of this study was to compare the incidence of surgical complications (duodenal perforation, postoperative vomiting, wound infection or dehiscence, incisional hernia) between 2 different surgical techniques for the resolution of hypertrophic pyloric stenosis in children. Methods: A clinically controlled, randomized study with follow-up from 24 to 36 months was conducted. One hundred children between 15 days and 2 months old, who underwent surgical resolution of hypertrophic pyloric stenosis, were put randomly into 2 groups: I, pyloric traumamyoplasty (n = 43); II, Fredet-Ramstedt pyloromyotomy (n = 57). Both groups were controlled for the main demographic variables. Postoperative follow-up was blind for the surgical team. Statistical analysis was done with simple frequencies, percentages, Student's t test, and χ². Results: There was not a single case of duodenal perforation, incomplete pyloromyotomy, wound infection, dehiscence, or incisional hernia in any group (P value, not significant). Postoperative emesis was present in 8 patients, uniformly distributed between groups. The operating room time for traumamyoplasty was 39.3 ± 16.4 minutes versus 54 ± 16.4 minutes for pyloromyotomy (P = .0003). Conclusions: This controlled study proves that traumamyoplasty is a simple procedure, quicker to perform, and as safe as pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis in children. For these reasons, the authors believe it should be considered as an alternative. J Pediatr Surg 36:1000-1003. Copyright © 2001 by W.B. Saunders Company.

Keywords:  Infantile hypertrophic pyloric stenosis, pyloric traumamyoplasty, Fredet-Ramstedt pyloromyotomy