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Journal of Paediatric Surgeons of Bangladesh
Original Articles · Vol. 1 No. 2 (2010)

To Manage Infantile Hypertrophic Pyloric Stenosis by "Double-Y Pyloromyotomy" is a better Surgical Approach

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JPSB
Journal of
Paediatric Surgeons of Bangladesh
Published : July 2010
CONTENTSVolume 01Number 2July 2010
Editorial
‘Constipation in Children’ – Think Twice Before Starting Treatment
Md. Kabirul Islam
86
Review Articles
Vaccination in Pregnancy
Shamim Fatema Nargis, Md. Shahinur Rahman
158
Original Articles
Operative Outcome of Acute Extradural Haematoma, Operated at Different Time Interval and Review of International Guidelines
MM Ehsanul Haque, S Sultana, SU Ahamed, Md. Abdullah Alamgir
88
Single Stage Correction of Rectovestibular Fistula
Kaniz Hasina, Abdul Hanif, S. M. Shafiqul Alam, Shahin Reza, Nazrul Islam, A. K. M. Mizanur Rahman, S. M. Shamsul Huda, M.M. Masud Pervez, Susankar Kumar Mondal, Shahnoor Islam
99
Bronchogenic Cyst
Mirza Kamrul Zahid, Anwarul Anam Kibria, AKM Razzaque, Md. Shamsul Alam, Shahinur Rahman, Kazi Saiful Islam
106
Comparison Between One Stage Correction of Vestibular Fistula by Transfistula Anorectoplasty (TFARP) and Anterior Sagittal Anorectoplasty (ASARP)
Jaglul Gaffer Khan, Mohammad Kabirul Islam, M. A. Rahaman, Jamila Akter, Kaniz Hasina, Susankar Kumar Mondal, Md. Ansar Ali
111
Correlation Between FNAC and Open Biopsy in Cervical Lymphadenopathy in Children
Tahmina Hossain, Md. Ruhul Amin, MTH Siddiqui, Md. Ashraf Ul Huq, Md. Matiur Rahman
118
Lubrication of Meatus and Circumcision Site for Prevention of Post-circumcision Meatal Stenosis in Children Younger Than Two Years Old
Susankar Kumar Mondal, Kaniz Hasina, Md. Ashraf Ul Huq, Md. Ansar Ali, Md. Mahbub-Ul Alam, Muhammed Moinul Hoque, Jaglul Gaffer Khan, A K M Mizanur Rahman, Shahnoor Islam
127
Postnatal Management of Prenatal Obstructive Hydronephrosis
Mugahid Al-Hassan, Paddy Dewan, Padma Rao
132
Study of Voiding Obstruction in Physiological Phimosis
Shahnoor Islam, AKM Amirul Morshed, Shafiqul Hoque
137
To Manage Infantile Hypertrophic Pyloric Stenosis by "Double-Y Pyloromyotomy" is a better Surgical Approach
Md. Ansar Ali, Kaniz Hasina, Shahnoor Islam, Md. Ashraf Ul Huq, Md. Mahbub-Ul Alam, Susankar Kumar Mondal
143
Use of Betel Leaves in Pediatric Stoma Care
Md. Ashraf Ul Huq, A K M Mizanur Rahman, Tahmina Hossain
148
Laparoscopic Repair of Peptic Ulcer Perforation - Our Initial Experience
Md. Saiful Hoque, Gazi Mohammad Zakir Hossain, Nur Hossain Bhuiyan, Md. Rashedul Hasan, Mayin Uddin Mahmud, Alamgir Rashid Chowdhury
153
Case Reports
Bilateral Lumbar Hernia - a Rare Occurrence in Infant
Shahnoor Islam, AKM Amirul Morshed, Md. Ashraf Ul Huq, Md. Mahbub-Ul Alam, Susankar Kumar Mondal, Kaniz Hasina
162
Inflammatory Pseudotumour of Mesentery - A Case Report
Bilal Mirza, Afzal Sheikh
166
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ASSOCIATION OF PAEDIATRIC SURGEONS OF BANGLADESH (APSB)
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Authors

  • Md. Ansar AliDept. of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka
  • Kaniz HasinaAssistant Professor, Dept. of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka
  • Shahnoor IslamAssistant Professor, Dept. of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka
  • Md. Ashraf Ul HuqAssociate Professor, Dept. of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka
  • Md. Mahbub-Ul AlamProfessor & Head, Dept. of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka
  • Susankar Kumar MondalResident, Dept. of Pediatric Surgery, Dhaka Medical College & Hospital, Dhaka

Keywords

Pyloric Stenosis pyloromyotomy double-Y pyloromyotomy Alayet’s pyloromyotomy

Abstract

Background: Different treatment modalities and procedures have been tried for the management of infantile hypertrophic pyloric stenosis. But surgery remains the mainstay for management of IHPS. Ramstedt’s pyloromyotomy was described almost over a hundred years ago and to date remains the surgical technique of choice. An alternative and better technique is the double-Y pyloromyotomy, which offer better results for management of this common condition. Methods: A prospective comparative interventional study of 40 patients with IHPS was carried out over a period of 2 years from July 2008 to July 2010. The patients were divided into 2 equal groups of 20 patients in each. The study was designed that all patients selected for study were optimized preoperatively regarding to hydration, acid-base status and electrolytes imbalance. All surgeries were performed after obtaining informed consent. Standard preoperative preparation and postoperative feeding regimes were used. The patients were operated on an alternate basis, i.e., one patient by Double-Y Pyloromyotomy (DY) and the next by a Ramstedt’s Pyloromyotomy (RP). Data on patient demographics, operative time, anesthesia complications, postoperative complications including vomiting and weight gain were collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessments were done by using t test. Results: From July 2008 through July 2010, fourty patients were finally analyzed for this study. Any statistical differences were observed in patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolytes imbalance and acid-base status were recorded. Significant differences were found in postoperative vomiting and weight gain. Data of post operative vomiting and weight gain in both groups were collected. Vomiting in double-Y (DY) pyloromyotomy group (1.21 ± 0.45 days) vs Ramstedt’s pyloromyotomy (RP) group (3.03 ± 0.37 days) p= 0.0001. Weight gain after 1st 10 days DY vs RP is (298 ± 57.94 gm vs 193 ± 19.8 gm p=0.0014), after 1 month (676.67 ± 149.84 gm vs 466.67 ± 127.71 gm, p=0.0001), after 2 months (741.33 ± 278.74 gm vs 490 ± 80.62 gm, p=0.002) and after 3 months (582 ± 36.01 gm vs 453.33 ± 51.64 gm, p=0.0001). No long-term complications were reported and no re-do pyloromyotomy was needed. Conclusion: The double-Y pyloromyotomy seems to be a better technique for the surgical management of IHPS. It may offer a better functional outcome in term of postoperative vomiting and weight gain.

Journal of Paediatric Surgeons of Bangladesh (2010) Vol. 1 (2): 143–147

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