COMPLICATIONS OF PYLOROMYOTOMY FOR INFANTILE HYPERTROPHIC PYLORIC-STENOSIS

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.