Long-term Gastrointestinal Sequelae in Children who Underwent Pyloromyotomy for Infantile Hypertrophic Pyloric Stenosis

Abstract

Aim

Pyloromyotomy, the treatment for infantile hypertrophic pyloric stenosis (IHPS), is a procedure with a low risk of short-term complications and quick recovery. However, at a later age, some children report gastrointestinal (GI) symptoms and recently we described a fatal case of adhesive small bowel obstruction years after pyloromyotomy. Therefore, the aim of this study was to evaluate long-term gastrointestinal sequelae of pyloromyotomy.

Methods

All children who underwent open or laparoscopic pyloromyotomy between 2007 and 2017 (n = 450), were invited to complete a questionnaire, which included the Pediatric Quality of Life Inventory™ Gastrointestinal symptoms module (PedsQL™ GI Module). Outcomes were compared to published healthy controls (n = 587) and between surgical approach by using an unpaired t-test.

Results

In total, 199 respondents completed the questionnaire. The majority (n = 172, 86.4 %) was male with a mean age of 11.4 (±3.1) years. Laparoscopic pyloromyotomy was performed in 104 children (52.3 %) and open pyloromyotomy in 95 (47.7 %). The PedsQL™ GI Module mean total score of all children who underwent pyloromyotomy was 88.6 (±11.0), which is comparable to healthy controls (88.6 (±12.9)). All subtopics were similar for children who underwent pyloromyotomy compared to healthy controls. There were no differences in scores of the PedsQL™ GI module between the open and laparoscopic subgroup.

Conclusions

The scores of the PedsQL™ GI module do not differ between children who underwent pyloromyotomy during infancy and healthy controls. Therefore long-term gastrointestinal sequelae of pyloromyotomy appear to be an exception. This evidence can be used during parental counseling. It also suggests that there is no need for long-term follow-up.