Peculiarities of surgical treatment of acute form of congenital hypertrophic pyloric stenosis
DOI:
https://doi.org/10.15587/2313-8416.2015.47365Keywords:
congenital hypertrophic pyloric stenosis, children, double pyloromyotomy, hypertrophy of the muscular coat of pylorus.Abstract
Aim of research: to study an efficiency of the double pyloromyotomy at congenital pyloric stenosis in children and its impact on regress of hypertrophy of pylorus in postoperative period.
Material and methods of research: there was carried out an analysis of 157 patients with an acute form of congenital hypertrophic pyloric stenosis (CHPS) that characterizes with a sudden beginning of disease, predominance of “fountain” vomiting over regurgitation, fast growth of homeostasis dysfunctions and decrease of the body weight. All children were separated in 2 groups statistically homogenous on sex, age and prescription of disease. The first group of examination (children who underwent the double pyloromyotomy) included 65 boys. The second (control) group included 92 male children who underwent the standard pyloromyotomy according to Frede-Weber-Ramstedt.
The ultrasound examination of pylorus in dynamics with detection of its volume was carried out in both groups.
Results. The results of intraoperative assessment of the state of injured pylorus indicate an existence of two macroscopic variants of it: “rigid pyloric olive” that was registered in 82 % of children of the first group and the “soft pyloric olive” – in 79% of patients of the control group. “Rigid olive” characterized with hard “cartilaginoid” consistency of fusiform thickened pylorus of the whitish color. “Soft olive” had the dense elastic consistency and the pink-pale color.
The regress of “pyloric olive” in all children took place on average during 67,92,2 (Mm) days. But in children of the second group medium terms of involution of hypertrophy of pylorus were 75,74,1 (Mm) days. In patients who underwent the double pyloromyotomy these terms were reliably (р0,05) lower and varied within 41,71,5 (Mm) days.
Conclusions. Involution of hypertrophy of pyloric end after the surgical treatment of CHPS occurs gradually and depends on adequacy of regeneration of the patency of pylorus. The double pyloromyotomy at an acute form of CHPS not only improve the patency of the pyloric segment of stomach during an early postoperative period but also accelerates the full regress of hypertrophy of pylorus from 75,74,1 (Мм) to 41,71,5 (Мм) days.
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