Ramsteads operation is done in:
Correct Answer: Congenital hypertrophic pyloric stenosis
Description: Ans: A (Congenital hypertrophic pyloric stenosis) Ref: Sabiston textbook of surgery, 19th Edition 1841Explanation:Congenital Hypertrophic Pyloric StenosisEtio PathologyOne of the most common G1 surgical disorders in early infancyMost common between the ages of 2 and 8 weeks.Boys are affected four times as often as girls,First-born male infants being at highest risk.Hypertrophy of the circular muscle of the pylorus results in constriction and obstruction of the gastric outlet, leading to nonbilious & projectile emesisEmesis leads to Loss of hydrochloric acid with the onset of hypokalemic hypochloremic metabolic alkalosis, and dehydration.Exact cause for HPS remains unknown, a lack of nitric oxide synthase in pyloric tissue has been implicated.Clinical PresentationProgressively worsening nonbilious emesis.With time, the emesis becomes more frequent, forceful, and projectile in nature.Occasionally, visible gastric peristalsis may be observed as a wave of contractions from the left upper quadrant to the epigastrium.Shortly after emesis, infants usually crave additional feedings.Palpation of the pyloric tumor (olive-shaped) in the epigastrium or right upper quadrant by an experienced examiner is pathognomonic for the diagnosis. If the olive is palpated, no additional diagnostic testing is necessary.InvestigationsAbdominal Radiograph:Upper abdominal gas bubble in the stomach.UltrasoundA persistent pyloric muscle thickness more than 3 to 4 mm or a pyloric length more than15 to 18 mm in the presence of functional gastric outlet obstruction is diagnostic. When the olive is nonpalpable. the diagnosis of HPS can be made by ultrasoundUpper GI ContrastWith equivocal clinical history, an upper Gl contrast study is useful to evaluate for other causes of vomiting.Treatment:Surgical ManagementThe treatment of HPS is pyloromyotomy (Ramstedt procedure)Incising through thickened pyloric musculature while preserving the underlying mucosaRight upper quadrant or periumbilical incision is usedLaparoscopic pyloromyotomy has better cosmesis. with similar outcomes to those of the open technique.Perioperative management:Before surgery, it is important that the infant be fully rehydrated with IV fluids to establish an adequate urine output and correct electrolyte disturbances such as metabolic alkalosis.Because the infant with underlying metabolic alkalosis will compensate with respiratory acidosis, postoperative apnea may occur. Thus, the serum HCO3 level needs to be normalized before surgery.Postoperative!}, infants are usually allowed to resume enteral feedings.Complications include incomplete myotomy, mucosal perforation, and wound infection
Category:
Surgery
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