F. Hulka et al., COMPLICATIONS OF PYLOROMYOTOMY FOR INFANTILE HYPERTROPHIC PYLORIC-STENOSIS, The American journal of surgery, 173(5), 1997, pp. 450-452
BACKGROUND: Few references exist regarding contemporary complications
of pyloromyotomy (PM) for infantile hypertrophic pyloric stenosis (IHP
S), Therefore, we reviewed the frequency and outcome of patients with
IHPS who developed complications from PM. METHOD: A 25-year retrospect
ive review was performed in two populations, The first group included
all infants who had a PM for IHPS at two pediatric surgery centers, Th
e second group included all infants referred from other institutions w
ho developed complications following PM for IHPS. RESULTS: Between 196
9 and 1994, 901 PMs were performed, Intraoperative complications occur
red in 40 patients (4%), including 39 duodenal perforations and 1 diff
icult intubation requiring prolonged ventilation. No unrecognized duod
enal perforations or incomplete PMs were found, Postoperative complica
tions developed in 52 patients (6%), The wound infection rate was less
than 1%, Postoperative vomiting occurred in 31 infants (3%), The mort
ality rate was 0.1%, with 1 death due to sepsis from delayed diagnosis
of Hirschsprung's disease, During the same study period, 11 patients
were referred from other hospitals for postoperative complications, Fi
ve had persistent vomiting treated successfully with expectant managem
ent, Six infants needed reoperation: 3 for persistent IHPS, 1 for gast
ric outlet obstruction, and 1 for small bowel obstruction secondary to
adhesions; 1 required wound abscess drainage. CONCLUSION: Pyloromyoto
my is not without complications, Duodenal perforation should be infreq
uent, but when it occurs, it can usually be readily recognized and tre
ated with minimal morbidity, Postoperative vomiting can be managed non
operatively, but if it persists longer than 5 days, radiologic evaluat
ion should be performed, Incomplete PM is uncommon and should not occu
r, A second myotomy is needed when the diagnosis of incomplete myotomy
is established, A single standard of care should be expected of all s
urgeons who perform PM for IHPS. (C) 1997 by Excerpta Medica, Inc.