title: Pyloromyotomy versus i.v. atropine therapy for the treatment of infantile pyloric stenosis: nationwide hospital discharge database analysis.
abstract: BACKGROUND
  Several studies have suggested that i.v. atropine has a potential role in treating infantile hypertrophic pyloric stenosis (IHPS). It remains unclear, however, whether surgery can be replaced by i.v. therapy.
  
  
  METHODS
  Data were extracted on infants with IHPS who were treated with atropine and/or surgery, from a nationwide administrative database through 2006-2008. Patient demographic data, treatment effects and length of hospital stay were analyzed in each treatment group.
  
  
  RESULTS
  A total of 585 infants met the criteria for IHPS; 188 patients (32%) were initially treated with atropine (i.v. form, n = 180; oral form, n = 8), while 397 were treated with surgery as a first-line therapy. Of the 180 infants receiving i.v. atropine, 38 were withdrawn from medical management and subsequently underwent surgery. Thus, the overall success rate of i.v. atropine was 78.9% (142/180). Surgery had a success rate of 100%, and postoperative complications were found in 2.8% of patients (12/435). Medical management required longer hospital stay than surgery (mean, 13.5 days vs 8.0 days; P < 0.001).
  
  
  CONCLUSIONS
  Surgery remains the suitable standard management option for IHPS, with its high success rate, minimal complications and shorter hospital stay compared with i.v. atropine therapy.
authors.affiliation: Department of Pediatrics, University of Tokyo Hospital, Tokyo, Japan. masatotakeuchi@gmail.com
authors.forename: Masato
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Yasunaga
authors.forename: Hiromasa
authors.initials: H
authors.lastname: Horiguchi
authors.forename: Hideki
authors.initials: H
authors.lastname: Hashimoto
authors.forename: Shinya
authors.initials: S
authors.lastname: Matsuda
mesh_terms: D001285:Atropine / Q000008:administration & dosage*; D016208:Databases, Factual; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D010276:Parasympatholytics / Q000008:administration & dosage; D010351:Patient Discharge / Q000706:statistics & numerical data*; D046248:Pyloric Stenosis, Hypertrophic / Q000628:therapy*; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010276:Parasympatholytics; D001285:Atropine
keywords: atropine; infusion; intravenous; pyloric stenosis; surgery