Surgical practice for infantile hypertrophic pyloric stenosis in the United Kingdom and Ireland--a survey of members of the British Association of Paediatric Surgeons

Purpose

Operative strategy and antibiotic policy in treating infantile hypertrophic pyloric stenosis (IHPS) may vary widely. This study surveys current practice in the United Kingdom and Ireland among members of the British Association of Paediatric Surgeons.

Methods

The study used postal and email survey of consultant pediatric surgeons.

Results

One hundred five questionnaires were distributed, and 94 replies (90% response) were received. Umbilical pyloromyotomy is performed exclusively by 57 surgeons. Fourteen surgeons (15%) use laparoscopy, whereas 5 (randomized trial in progress) use the umbilical or laparoscopic route. Eight reported that the umbilical or classical right upper quadrant (RUQ) incision is undertaken at their institution according to surgeon's preference. Ten surgeons only deploy an RUQ incision. Antibiotic practice showed that 40 (70%) using the umbilical incision prescribe prophylactic therapy, whereas only 6 adopting other operative techniques (RUQ incision or laparoscopy) found this policy beneficial. More than 50% surveyed do not routinely recommend antibiotics.

Conclusion

Umbilical pyloromyotomy is used by most pediatric surgeons in the United Kingdom and Ireland. Laparoscopy is increasingly popular in minimally invasive centers. The RUQ incision is used by a minority of surgeons. Antibiotic prophylaxis was common with the umbilical incision only. The superior cosmetic results offered by umbilical pyloromyotomy and laparoscopy are a benchmark for surgeons currently providing contemporary care for babies with IHPS.