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Hypertrophic Pyloric Stenosis History The history of what we now refer to as infantile hypertrophic pyloric stenosis dates back to the early 1700s. Blair described an infant with postmortem findings consistent with hypertrophic pyloric stenosis in 1717. Epidemiology Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of gastric outlet obstruction in infants. The prevalence of IHPS ranges from 1.5 to 4.0 per 1000 live births in Caucasian infants but is less prevalent in African-American and Asian children. Reports have suggested that the incidence is increasing. It is well known that it is more common in boys than girls, with a ratio of approximately 2:1 to 5:1. The occurrence of IHPS has been associated with several variables including both environmental and familial factors. IHPS is now thought to be caused by a mechanism other than a developmental defect. Anatomy The gross appearance of the pylorus in IHPS is that of an enlarged,pale muscle mass usually measuring 2 to 2.5 cm in length and 1 to 1.5 cm in diameter. Etiology The etiology of IHPS has eluded investigators for several decades and no definitive causative factors have been identified. Both genetic and environmental factors seem to play a role in the pathophysiology. Another focus has been on alterations in relaxation of the pyloric muscle. As new technology and concepts have evolved,additional associations that involve IHPS and gastrointestinal peptides, growth factors, neurotrophins, changes in neural development, and nitric oxide have been described. Diagnosis Nonbilious projectile vomiting. Visible peristaltic waves in the left upper part of the abdomen. Diagnosis can be made in 75% of infants with IHPS by careful physical examination of the upper part of the abdomen.you can palpate an enlarged pylorus. US(ultrasound) has become not only the most common initial imaging technique for the diagnosis of IHPS but also the standard for diagnosing IHPS. Hypochloremic、Hypokalemic、Metabolic alkalosis. Treatment Minimal Laparotomy (“Open”) Technique Treatment Laparoscopic Procedure 1 2 3 Treatment (postoperative management ) In the majority of infants, feeding can be started within 4 hours after the surgical procedure. Infants with hematemesis from gastritis may benefit by delaying feeding for an additional 6 to 12 hours after the procedure. Postpyloromyotomy Feeding Schedule For very small infants, the starting feeding volume may be reduced to 15 mL and the schedule stopped at volumes of 60 to 75 mL, which provide an adequate calorie supply. Complications Complications after pyloromyotomy should be minimal if performed by experienced surgeons. Perforation (In a large series of infants undergoing open pyloromyotomy, the incidence of perforation was 2.3%). Wound-related complications occurred in 1%. Thank you