Rickham's Neonatal Surgery by Paul D. Losty Alan W. Flake Risto J. Rintala John M. Hutson & Naomi lwai

Author:Paul D. Losty, Alan W. Flake, Risto J. Rintala, John M. Hutson & Naomi lwai
Language: eng
Format: epub
Publisher: Springer London, London

30.8 Other Treatment Options

The mainstay of management for almost 100 years now has been the successful use of an operative approach whether by an open or laparoscopic method. An alternative interventional approach has been reported on in studies from Japan [179, 180]. Here, balloon dilatation of the pylorus can be undertaken via an endoscopic technique, analogous to that with oesophageal strictures. However this may be associated with a higher perforation rate and non-resolution of symptoms, and so is unlikely to displace the use of traditional interventions.

Prior to the establishment of the Ramstedt procedure however, medical management was the main approach and is still reported on in some studies from more recent times. In the early twentieth century the treatment was based on trying to maintain feeding regimes until the eventual resolution of the condition [181, 182, 183] though the success was not great. The introduction of an oral form of atropine was reported to give improved success [183] though it was recognised that intensive and prolonged nursing care was required [184].

A number of studies from Japan have identified that the use of atropine as a primary treatment along with both fluid and nutritional support have been effective in managing the condition [186, 187, 188]. The studies have shown success with the use of a regime of intravenous followed by oral atropine. Here though, the in-patient stay was significantly longer than a comparable group undergoing surgery [185] and the total course of treatment was on average 3 months after initial diagnosis. This alone would call into question the economic benefit of the procedure. Yet, given it can be successful and with no reported side-effects, it is a strategy that could be used in children who for varied reasons may not be appropriate for surgical intervention.

Download

Copyright Disclaimer:
This site does not store any files on its server. We only index and link to content provided by other sites. Please contact the content providers to delete copyright contents if any and email us, we'll remove relevant links or contents immediately.