Treatment of infantile hypertrophic pyloric stenosis in a district general hospital: A review of 160 cases

Background: Ramstedt's pyloromyotomy has long been the standard operation for the treatment of infantile hypertrophic pyloric stenosis. Controversy exists over whether this procedure can be performed safely in the district general hospital setting or whether it should be restricted to specialist pediatric units only. Methods: Retrospective analysis was performed on the medical records of a series of 160 infants treated by Ramstedt's pyloromyotomy by 2 surgeons in a district general hospital over 16 years. Results: There was no perioperative mortality. Oral feeding was achieved by 24 hours in 76% of infants, and there was persistent vomiting in only 3.8%. Wound discharge was encountered in 4.4% and confirmed wound infection in 1.3%. Wound dehiscence occurred in 1.9% of infants. Inadvertent mucosal perforation occurred in 19% of cases, although all cases were recognized and repaired at once with no apparent ill effects. These results are comparable with those reported from specialist pediatric units and from pediatric surgeons working within general surgical units. Conclusions: Infantile hypertrophic pyloric stenosis can be treated safely in a district general hospital when care is provided by appropriately trained surgical, anesthetic, and pediatric staff. (C) 2003 Elsevier Inc. All rights reserved.