Hypertrophic pyloric stenosis

In hypertrophic pyloric stenosis, the stomach outlet is obstructed by the muscle (known as the pylorus), which is too thick and too long. The ingested breast milk cannot flow into the duodenum and backs up. This results in the typical gushing vomiting. The cause of hypertrophic pyloric stenosis has not yet been clarified. It typically occurs in infants between the third and twelfth week of life. Male and first-born babies are more frequently affected.

The infants vomit the undigested breast milk in gushes. If the vomiting continues for several days, the children show further symptoms such as exhaustion, fluid and weight loss.

The diagnosis is based on the patient's medical history, the physical examination and an ultrasound or contrast imaging of the abdomen.

The immediate therapy is to replace the lost electrolytes. The infants are hospitalised, receive a gastric tube and fluids via a vein. Only when the electrolytes and fluid balance have normalised is the operation performed (typically on the second or third day after admission to hospital). The operation consists of surgically splitting the thickened stomach pouch. This can be performed either open or minimally invasive. The UKBB recently compared and published the open and minimally invasive surgical methods in the leading medical journal and performs this operation minimally invasively with three tiny incisions, so that later scars are practically invisible.

The hospitalisation lasts about four to five days in total.

The prognosis for hypertrophic pyloric stenosis is very good. Most children recover quickly from the procedure and are able to drink full portions and thrive again after a few days. No effects on later life are to be expected.

• Open versus laparoscopic pyloromyotomy for pyloric stenosis. Staerkle RF, Lunger F, Fink L, Sasse T, Lacher M, von Elm E, Marwan AI, Holland-Cunz S, Vuille-Dit-Bille RN.Cochrane Database Syst Rev. 2021 Mar 9;3(3)
• Open Versus Laparoscopic Pyloromyotomy for Pyloric Stenosis-A Systematic Review and Meta-Analysis. Lunger F, Staerkle RF, Muff JL, Fink L, Holland-Cunz SG, Vuille-Dit-Bille RN.J Surg Res. 2022 Jun;274:1-8.