title: Infantile hypertrophic pyloric stenosis: has anything changed?
abstract: OBJECTIVE
  The study aims to review the contemporary presentation, diagnosis and treatment of children with infantile hypertrophic pyloric stenosis (IHPS) at an Australian paediatric tertiary centre.
  
  
  METHODS
  A retrospective case review of patients with IHPS presenting to our institution between January 2004 and December 2010 was performed. Results were compared with a previous study evaluating two earlier 6-year series of patients treated between January 1984 and November 1995.
  
  
  RESULTS
  Of 362 infants presenting over the current 7-year review, 84.8% were male. Mean age of admission fell from 5.9 weeks in the previous study to 5.4 weeks. An 'olive' was palpated on examination in 48%, visible peristalsis seen in 25% and 16% of patients presented with haematemesis. Diagnosis solely on clinical examination fell from 74% to 9% and was associated with a corresponding increase in use of ultrasound from 16% to 91%. The frequency of serum chloride values less than 85 mmol/L declined from 26% to 9%. A variety of open and minimally invasive surgical approaches were used with similar outcomes, although laparoscopic pyloromyotomy was associated with significantly higher rates of wound infection (χ(2) = 4.6, P = 0.03). The frequency of major complications remained low at 1%.
  
  
  CONCLUSIONS
  Contemporary patients with IHPS typically present earlier with a reduction in the incidence of metabolic derangement. Diagnosis based on clinical examination alone appears uncommon, with the majority of suspected cases confirmed by ultrasound. There was no clear difference in overall outcome based on the surgical approach used, although minor variations may reflect our institution's initial experience with laparoscopic pyloromyotomy.
authors.affiliation: Douglas Cohen Department of Paediatric Surgery, The Children's Hospital at Westmead, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Nicole D
authors.initials: ND
authors.lastname: Taylor
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Cass
authors.forename: Andrew J A
authors.initials: AJ
authors.lastname: Holland
mesh_terms: D042241:Early Diagnosis; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009517:New South Wales; D011183:Postoperative Complications / Q000453:epidemiology; D046248:Pyloric Stenosis, Hypertrophic / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000601:surgery; D011708:Pylorus / Q000601:surgery; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014463:Ultrasonography