Hypertrophic Pyloric Stenosis (HPS)

I. Anatomy of the Stomach

1. Cardia
2. Fundus
3. Body
4. Pylorus

II. Incidence and Prevalence

- 1–4 per 1000 live births
- 4:1 male-to-female ratio

III. Etiology
Multi-factorial with environmental influences

IV. Symptoms and Signs

a) Symptoms
§ Progressive non-bilious projectile vomiting at 2-8 weeks of
full-term infant
b) Signs
§ Olive mass is palpable in 70-90% of patients
§ Dehydration in cases of late presentation

V. Investigations

a) Radiology
§ Ultrasonography is the standard technique for diagnosis of HPS
§ Upper gastrointestinal contrast studies may be helpful if US is
non-conclusive

b) Laboratory
§ ABG: Hypochloremic hypokalemic metabolic alkalosis
§ CBC, PT, PTT, INR
 VI. Treatment

1. Resuscitation

§ HPS is not a surgical emergency and resuscitation is of the

utmost priority. Inadequate resuscitation can lead to
postoperative apnea
§ Electrolytes should be checked every 6 hours until they
normalize, and the alkalosis has resolved.

2. Surgical Intervention: Pyloromyotomy

§ Open Approach (Ramstedt Operation)

§ Laparoscopic Approach

VII. Post-Operative Care

1. Continue resuscitation of the patient

2. Ad libitum feeding
3. Pain management

VIII. Complications

§ Mucosal perforation
§ Prolonged postoperative emesis; either due to GERD or
inadequate splitting of the muscles
§ Incomplete myotomy
§ Wound infection
§ Incisional hernia