PROSPECTIVE STUDY OF TREATMENT OUTCOMES AND RISK FACTORS IN INFANTILE HYPERTROPHIC PYLORIC STENOSIS

Abstract

Background: Infantile Hypertrophic Pyloric Stenosis (IHPS) is a common cause of gastric outlet obstruction in early infancy requiring timely surgical intervention to prevent morbidity and mortality.

Objective: To evaluate treatment outcomes and associated factors of IHPS in infants managed at Mardan Medical Complex (MMC), Mardan.

Methodology: This prospective, hospital-based observational study included 120 infants diagnosed with IHPS and surgically managed at MMC from January 2022 to December 2024. Data on demographics, clinical presentation, preoperative hydration and electrolyte status, surgical approach, intraoperative findings, postoperative complications, and length of hospital stay were collected using a structured proforma. Open and laparoscopic pyloromyotomy were performed, and patients were followed for 30 days postoperatively. Descriptive statistics summarized patient characteristics and outcomes, while chi-square and independent t-tests assessed associations between preoperative factors and poor outcomes. A p-value <0.05 was considered statistically significant.

Results: Among 120 infants, 93 (77.5%) were male and 27 (22.5%) females; 56 (46.7%) presented at 5–8 weeks of age. Preoperatively, 42 (35.0%) had severe dehydration and 83 (69.2%) had electrolyte imbalance. Open pyloromyotomy was performed in 98 infants (81.7%), and laparoscopic surgery in 22 (18.3%). Intraoperative complications occurred in 11 infants (9.2%). Postoperatively, vomiting within 24 hours occurred in 34 infants (28.3%), wound infection in 10 (8.3%), mucosal perforation in 4 (3.3%), reoperation in 2 (1.7%), and mortality in 3 (2.5%), resulting in 15 infants (12.5%) with poor outcomes. Severe dehydration, electrolyte imbalance, and age >8 weeks were significantly associated with poor outcomes (p<0.01). Mean hospital stay was 4.3 ± 1.7 days, prolonged in those with poor outcomes.

Conclusion: IHPS can be effectively managed surgically, with early diagnosis and preoperative stabilization critical in improving outcomes.