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Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the "olive"?
- Source :
-
Journal of pediatric surgery [J Pediatr Surg] 2005 Dec; Vol. 40 (12), pp. 1848-51. - Publication Year :
- 2005
-
Abstract
- Background/purpose: Laparoscopic pyloromyotomy has recently gained wide acceptance as the optimum treatment of infantile hypertrophic pyloric stenosis (IHPS). However, medical treatment may be superior to laparoscopic surgery in invasiveness. The efficacy of our regimen of intravenous atropine therapy for IHPS was assessed in comparison with surgical treatment.<br />Methods: Medical treatment was initially chosen for 52 (61%) of 85 infants with IHPS at our institute between 1996 and 2004. Atropine was given intravenously at 0.01 mg/kg 6 times a day before feeding. When vomiting ceased and the infants were able to ingest 150 mL/kg per day of formula after stepwise increases in the feeding volume, they were given 0.02 mg/kg atropine 6 times a day orally, and the dose was decreased stepwise.<br />Results: Of the 52 patients, 45 (87%) ceased projectile vomiting with treatment using intravenous (median, 7 days) and subsequent oral (median, 44 days) atropine administration. The median hospital stay was 13 days (6-36), and no significant complications were encountered during atropine therapy. The remaining 7 patients required surgery. Of 40 who underwent surgery, 4 had wound infections and 1 with hemophilia had postoperative hemorrhagic shock. The patients who underwent successful atropine therapy had body weights comparable with those who underwent surgery at the age of 1 year.<br />Conclusions: The high success rate of intravenous atropine therapy for IHPS suggests that this therapy is an effective alternative to pyloromyotomy if the length of the hospital stay and the necessity of continuing oral atropine medication are accepted.
- Subjects :
- Atropine administration & dosage
Female
Humans
Infant
Infant, Newborn
Infusions, Intravenous
Laparoscopy
Male
Parasympathomimetics administration & dosage
Postoperative Complications
Pyloric Stenosis, Hypertrophic complications
Pyloric Stenosis, Hypertrophic surgery
Retrospective Studies
Treatment Outcome
Vomiting etiology
Atropine therapeutic use
Parasympathomimetics therapeutic use
Pyloric Stenosis, Hypertrophic drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1531-5037
- Volume :
- 40
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of pediatric surgery
- Publication Type :
- Academic Journal
- Accession number :
- 16338303
- Full Text :
- https://doi.org/10.1016/j.jpedsurg.2005.08.025