الفهرس 
Historical background, etiology and of IHPSOnly 14 pages are availabe for public view
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Abstract
Infantile Hypertrophic Pyloric Stenosis is a common cause of gastric outlet obstruction in infants. It is caused by diffuse hypertrophy and hyperplasia of the smooth muscle of the antrum of the stomach and pylorus. It usually occurs in infants aged 2-8 weeks. No definitive cause for hypertrophic pyloric stenosis has been found.
Typical presentation is onset of projectile vomiting, persistent hunger, weight loss, dehydration, lethargy and infrequent or absent bowel movements may be seen. Stomach wall peristalsis may be visible. Enlarged pylorus classically described as an ’olive’, can usually be palpated in the right upper quadrant or epigastrium of the abdomen.
Patients with nonbilious vomiting typically have Infantile Hypertrophic Pyloric Stenosis or reflux. Other conditions that can manifest with nonbilious vomiting include pylorospasm, hiatal hernia and preampullary duodenal stenosis.
Ultrasound examination confirms the diagnosis in the majority of cases, allowing an earlier diagnosis in infants with suspected disease but no pyloric mass on physical examination. Criteria for diagnosis include pyloric thickness greater than 3mm or an overall pyloric length greater than 14mm. Ultrasonography has a sensitivity of approximately 95%.
Nuclear medicine scanning is not routinely used for hypertrophic pyloric stenosis; however, possible findings include delayed gastric emptying. Endoscopy has been advocated by some investigators as a successful tool in the diagnosis of IHPS. Demonstration of the cauliflower- or nipple-like projection of the mucosa is characteristic in patients with Infantile Hypertrophic Pyloric Stenosis.
Fredt-Ramstedt pyloromyotomy performed through a right upper quadrant transverse incision is the gold standard in treatment of infantile hypertrophic pyloric Stenosis allover the past century.
In the recent 25 years, laparoscopic and circum-umbilical approaches have been introduced as alternatives to improve the cosmetic results. The 3 approaches had comparable favorable outcomes. Remarkable differences were in the learning curve of the technique evidenced by the operative time. The other main difference was the final cosmetic appearance. Therefore, the right upper quadrant (RUQ) approach is the standard and easiest-to-master approach while laparoscopic pyloromyotomy (LPM) and circum-umbilical (pyloromyotomy) (UMB) offered the potential of a better cosmetic outcome.