Infantile hypertrophic pyloric stenosis: Perspective from a developing country

Authors

  • Kashaf Khalid Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
  • Saman Hamid Medical College, Aga Khan University, Karachi, Pakistan
  • Muhammad Mussab Khakwani Medical College, Aga Khan University, Karachi, Pakistan
  • Areej Salim Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.
  • Shabbir Hussain Department of Surgery, The Aga Khan University Hospital, Karachi, Pakistan.

DOI:

https://doi.org/10.46831/jpas.v2i2.153

Keywords:

Hypertrophic pyloric stenosis, Pediatric, Surgery, Feed

Abstract

Background: Infantile hypertrophic pyloric stenosis (IHPS) is pyloric muscle hypertrophy that causes gastric outlet obstruction. This study explores the prevalence of IHPS and the challenges in its diagnosis and treatment in a developing country. The study aimed to identify factors contributing to delays in the diagnosis and treatment of IHPS and compare the management practices for IHPS at the study hospital with international surgical guidelines.

Methods: A retrospective cross-sectional study was conducted at The Aga Khan University Hospital. Data were collected from records of 126 pediatric patients diagnosed with IHPS between January 2015 and 2019. Quality parameters, including delay in presentation, diagnosis, referral, surgery, diagnostic modalities, surgical practice, post-operative feeding, and hospital stay, were assessed. Statistical analysis was performed using SPSS version 22.

Results: Of the 44 included patients, the majority (84%) were male. The mean age at presentation was 5.2 weeks. Ultrasound was the primary diagnostic modality (81.8%), with upper GI studies used in 11.3% of cases. Delays in presentation and diagnosis were observed, with parents' delay being a major factor. The mean lag time between symptoms and surgical consult was 11.2 days, contributing to delays. Complications correlated with increased lag times.

Conclusion: This study reveals variations in IHPS management compared to international guidelines. The hospital predominantly uses an open Ramsted's pyloromyotomy, while laparoscopic surgery is recommended. Postoperative feeding initiation and discharge practices differ from international standards. Delays in diagnosis result from the disease's rarity and a lack of trained surgeons. The study underscores the need to educate primary care physicians and parents for early IHPS referral. IHPS management can be optimized by addressing delays, improving surgical practices, and ensuring early referral and intervention.

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Published

2024-03-22

How to Cite

1.
Khalid K, Hamid S, Khakwani MM, Salim A, Hussain S. Infantile hypertrophic pyloric stenosis: Perspective from a developing country. J Pediatr Adolesc Surg [Internet]. 2024Mar.22 [cited 2024Nov.6];2(2). Available from: http://jpedas.org/ojs/index.php/jpedas/article/view/153
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