الفهرس 
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Abstract
Congenital hypertrophic pyloric stenosis (CHPS) is a common surgical pathology with an unknown aetiology in children (Schechter et al., 1997). The incidence of CHPS is approximately two to five per 1,000 live births per year in most white populations, although it varies with the geographic area (Jedd et al., 1988 &; Applegate & Druschel, 1995) CHPS is less common in black and Asian populations, with a frequency that is one third to one fifth that in the white populations (Schechter et al., 1997). Males (especially firstborns) are affected approximately four times as often as females, with reported ratios ranging from 2.5:1 to 5.5:1 (Mitchell & Risch, 1993).
The pathology of CHPS entails hypertrophy of the circular muscle fibers of the pylorus leading to obstruction of the pyloric canal leading to vomiting and giving the classical picture of CHPS(Fujimoto et al., 1999). The classic presentation of CHPS is the onset of postprandial non-bilious emesis in an otherwise healthy infant aging 2 to 8 weeks, with a peak occurrence at the 3rd to the 5th week of age. Symptoms may rarely develop as early as the 1st week of life and as late as the 5th month (Richard et al., 2003). Weight loss and dehydration coupled with an insatiable appetite lead to a characteristic facies, with a furrowed brow, wrinkled appearance, and prominent sucking pads, resembling an old man crying inconsolably and gnawing at his or her fist. (Hernanz-Schulman, 2003). Ultrasound is usually the primary imaging modality , and it’s advantages over a barium meal are that it directly visualizes the pyloric muscle and does not use ionizing radiation. Unfortunately it is incapable of excluding other diagnoses such as midgut volvu¬lus (Blumhagen et al.,1988).
Once the diagnosis is established, oral feedings should be discontinued. If a contrast study has been performed, an orogastric or a nasogastric tube should be used to irrigate the stomach and remove any residual contrast to avoid the risk of perioperative aspiration after which the tube is not necessary and may remove additional fluids and hydrochloric acid from the stomach (Oldham & Aiken, 2007). In spite of the high frequency of this condition, there is no general agreement about the best surgical technique for the treatment of CHPS. The routine operation has been pyloromyotomy with cutting of the hypertrophied pyloric muscle with different approaches being used to achieve this goal (either Trans rectal transverse abdominal incision; a circmumbilical incision or via laparoscopy) (Fujimoto et al., 1999).
The technique of Double Y pyloromyotomy was introduced as it seems to be a good technique for the surgical management of CHPS. It offered a better functional outcome in terms of postoperative vomiting during the first postoperative week and weight gain during the first 10 days in our initial series while having a safety profile similar to Ramstedt’s pyloromyotomy Alalayet.