COMPARISON OF ATROPINE SULFATE WITH PYLOROMYOTOMY FOR TREATMENT OF INFANTILE HYPERTROPHIC PYLORIC STENOSIS

In hypertrophic pyloric stenosis (HPS) the hypertrophied muscles of pylorus cause partial gastric outlet obstruction. The standard management of HPS is pyloromyotomy. However, successful treatment of HPS with atropine sulfate also has been reported. We aim to compare the outcomes of medical and surgical treatment for HPS.

Materials & Methods: In this comparative clinical trial at Imam Khomeini hospital of Urmia and Nemazi Hospital of Shiraz, infants with diagnosis of hypertrophic pyloric stenosis -after obtaining writing consent from parents- were treated with intravenous atropine sulfate (0.01 mg/kg/q3h) and then orally. The results were compared with cases of surgical pyloromyotomy. The data were analyzed with SPSS and t-test was used for comparing quantitative variables and chi2 test for qualitative variables.

Results: A total of 26 infants with hypertrophic pyloric stenosis (11 in Urmia, 15 in Shiraz) were treated with intravenous atropine sulfate, in which three were excluded because of associated anomalies. From the 23 infants (18 male and 5 female) in 19 patients (82.6%) ceased vomiting after treatment with intravenous (median 4.6 days) and subsequent oral atropine sulfate, without major complications. Atropine sulfate was effective in 94.4% of boys but in 40% of girls. Stopping period of vomiting was prolonged in atropine group. (P=0.01) But cost of admission was more in surgical group. (P=0.02) Length of the hospital stay in surgical group was slightly less than medical group with no significant difference. (P=0.42)

Conclusions: In this study, atropine was effective in most of infants with hypertrophic pyloric stenosis.