TITLE:
Do Immaturity, Dehydratation or Alkalosis Predispose to Intraoperative Complications at Pyloromyotomy?
AUTHORS:
Ralf-Bodo Tröbs, Lars Burghardt, Micha Bahr, Matthias Nissen
KEYWORDS:
Hypertrophic Pyloric Stenosis, Pyloromyotomy, Complication, Perforation, Alkalosis, Surgical Training
JOURNAL NAME:
Open Journal of Pediatrics,
Vol.6 No.3,
August
9,
2016
ABSTRACT: Background: Hypertrophic pyloric stenosis is the most important
cause for propulsive non-bilious vomiting in infants of the first trimester.
Extramucous splitting of the hypertrophic pyloric muscle is the surgical gold
standard for treatment. Serious major complications of pyloromyotomy (PM) are
mucosal perforation and incomplete muscle splitting. The aim of the presented
study is to find out if intraoperative complications are predisposed by
biometric or biochemical factors. Furthermore, we looked for the influence of
the board certification of the primary surgeon. Patients and Methods: 162 infants with IHPS were operated during a six-year period (n = 150 laparoscopic operations). We had 8 major
complications (4.9%): iatrogenic mucosal perforation occurred in 6 cases, and
incomplete PM in 2 infants. Preoperative demographic data and data resulting
from the blood acid-base- and ion-analysis were compared with data of a previously
published reference group from our institution (Tr?bs RB. Open J Pediatr, 2014; 4: 208-215). Results: The duration of vomiting,
the grade of dehydration and the severity of blood alkalosis did not differ
between both groups. Furthermore, we found no influence of the gestational age
and birth weight on the occurrence of intraoperative complications. It seems
that early postnatal age (p = 0.07) and low body weight at surgery (p = 0.055)
may contribute to surgical problems. Board certification as a paediatric
surgeon did not influence the rate of intraoperative complications. Conclusions: Laboratory data did not show any predisposition to intraoperative
complications. It is assumed that small infants with early occurring symptoms
carry an elevated risk for intraoperative events. Our data support the
hypothesis that the rate of intraoperative complications at PM is mainly
influenced by skills and experience of the surgeon.