Double-Y pyloromyotomy: a new technique for the surgical management of infantile hypertrophic pyloric stenosis.

BACKGROUND: Many innovations and approaches have been tried for the surgical management of infantile hypertrophic pyloric stenosis (IHPS) since Ramstedt's first successful surgery almost one hundred years ago. We define here a new technique focusing on the pylorus which may offer better results for this common condition.

METHODS: A prospective study of 40 patients with infantile hypertrophic pyloric stenosis was carried out over a period of 3 years, from January 2005 to January 2008. The patients were divided into 2 equal groups of 20 patients each. The study was designed that all patients selected for the study would be optimized preoperatively with regard to hydration, acid-base status and electrolyte 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 Ramstedt's pyloromyotomy and the next with a double-Y pyloromyotomy. Data on patient demographics, operative time, anesthesia complications, complications, postoperative vomiting and weight gain was collected. Patients were followed up for a period of 3 months postoperatively. Statistical assessment was done using Student's T-test.

RESULTS: No significant statistical differences were found in the patient population regarding age, sex, weight at presentation, symptoms and clinical condition including electrolyte imbalance and acid-base status. The groups were also equal in terms of anesthesia and no anesthesia-related complications occurred. However a significant difference was noted in vomiting during the first postoperative week between the double-Y pyloromyotomy (DY) and the Ramstedt's pyloromyotomy (RP) group (2.7 +/- 0.98 days vs. 3.45 +/- 0.94 days; p = 0.018) and in the weight gain during the first 10 postoperative days (245.50 +/- 24.17 g vs. 225.25 +/- 21.61 g; p = 0.008) respectively. No long-term complications were reported and no redo pyloromyotomies were needed.

CONCLUSION: The double-Y pyloromyotomy (Alayet's pyloromyotomy) seems to be a good technique for the surgical management of IHPS. It offered a better functional outcome in terms of postoperative vomiting during the first postoperative week and weight gain during the first 10 days in our initial series while having a safety profile similar to Ramstedt's pyloromyotomy.