Efficacy Medical Treatment as an Alternative to surgical treatment in Management of Infantile Hypertrophic Pyloric Stenosis (IHPS)

Background: Background: Pyloromyotomy is considered the main surgical management for treatment of Infantile Hypertrophic Pyloric Stenosis(IHPS). Medical treatment with atropine therapy for management IHPScould be even more beneficial than open surgery and laparoscopic pyloromyotomy mainly in infants with major congenital anomaly orcomorbid conditions and in cases of refusal of patients to perform surgery to the infants. Aims: To evaluate and assess the values and efficacy of atropineas a non-surgical alternative to pyloromyotomy in management of IHPSand to investigate the sonographic changes of the pyloric canal, thebenefits and adverse effects of atropine, with special consideration to improvement of pyloric hypertrophy. Patients and methods: we have included 25 infants with clinical and sonographic evidences of having IHPS. We give them intravenous atropine at a dose of 0.01 mg/kg 6 times daily before feeding. When vomiting decreased and they became able to take oral formula of about 150 ml/kg/day; we gradually increased the feeding volume then we gave them oral atropine 0.02 mg/kg six times a day and then we decreased the dose was gradually and we noticed and reported improvements. Results: we found that 20 (80%) of our included 25 infants have stopped projectile vomiting after intravenous atropine treatment in a median time of 7 days and then oral atropine intake followed for about median 44 days. We proved that there are no significant complications occurred from atropine treatment. Ultra-sonography revealed that there was a significant decrease in pyloric muscle thickness, but there was no significant shortening of the pyloric canal after termination of the medical treatment with atropine. At presentation our in included infants exhibited failure to thrive, but they were thriving at 6 months of age (p < 0.01). The remaining 5 infants were not improved with IV atropine and they required surgery 4 infants of them showed dramatic improvement of vomiting after surgery (p < 0.01). Conclusions: in IHPS medical treatment with atropine resulted in a clinical recovery and a significant reduction in pyloric muscle thickness, so that this therapy is an effective alternative to pyloromyotomy if the length of the hospital stay and the need of continuing oral atropine medication are accepted by the parents of the infants.