Medical treatment of infantile hypertrophic pyloric stenosis: should we always slice the "olive"?
OBJECTIVE
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.


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.


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.


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.
Kawahara
Hisayoshi
H
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka 594-1101, Japan. kawahara@mch.pref.osaka.jp
Takama
Yuichi
Y
Yoshida
Hideki
H
Nakai
Hiroshi
H
Okuyama
Hiroomi
H
Kubota
Akio
A
Yoshimura
Norikazu
N
Ida
Shinobu
S
Okada
Akira
A
D001285:Atropine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007262:Infusions, Intravenous; D010535:Laparoscopy; D008297:Male; D010277:Parasympathomimetics / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications; D046248:Pyloric Stenosis, Hypertrophic / Q000150:complications / Q000188:drug therapy* / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology
D010277:Parasympathomimetics; D001285:Atropine