Pyloric Stenosis’ Game-changer

The German Dr Conrad Ramstedt’s surgical remedy for infant pyloric stenosis was announced to the world at a medical conference and publication in 1912.

This event hardly affected the great majority of the human race, but it was of course rather significant for someone who underwent that surgery 33 years later to save his life just 10 days after his mother gave him birth.  And because pyloric stenosis (“PS”) affects between 3 and 5 babies in every thousand born in developed countries, and most of these are treated surgically, there are many people alive today because of Ramstedt’s discovery.

However, one only has to research the history of this condition and its treatment to realise that whilst the German doctor realised he had made a significant discovery, he was also the unwitting cause of trauma in at least some and perhaps many PS babies and their parents.  Let me explain…

In 1912, the medical treatment of PS babies was the rule but very risky, and almost half the infants died despite it.  Several surgical techniques were then being offered as an alternative for PS babies, but these were so drastic and severe on a tiny, malnourished and dehydrated baby that the great majority died of surgical shock, infection, and other related causes.  Most parents took their chances with the available medicines… and prayed.

Ramstedt Conrad im Op RaphaelKlinik1a
Dr Conrad Ramstedt operating at the St Raphaelklinik

Dr Conrad Ramstedt’s accidental discovery in 1911 was published in October 1912 and represented a major breakthrough: see this post and this one.  The Ramstedt pyloromyotomy was rapidly adopted as the remedy of choice in most developed countries around the world, and in four decades after 1912, deaths from PS fell to almost nil in most countries.  However, even in the 1940s, some countries (including Great Britain) continued to report their PS mortality was still at 25%.  I have been shocked by how many mentions there are on the web of relatives dying of PS, even in the 1950s.  Despite all this, Ramstedt’s technique and better health standards in hospitals have done much to make death from PS most uncommon today.

How did the Ramstedt pyloromyotomy contribute to this?

150414-011It made treating PS relatively easy and simple for surgeons, hospital staff, and parents. For surgeons the technique requires practice and care, but is essentially one of the simplest surgical procedures on the surgeries list.  The surgery usually ends the violent and deadly vomiting; although some continued vomiting and reflux occur quite often, it is fairly rare that an incomplete myotomy (division of the pyloric muscle) or the muscle’s redevelopment requires a repeat of the surgery.  So: anxious parents are greatly relieved, the surgeon immediately becomes a warrior-hero, and the baby quickly starts to make up for weight lost: I gather that my post-op photo is quite typical!

Apart from the great relief of all concerned, the Ramstedt pyloromyotomy saves pediatric ward staff and the bay’s parents from having to manage (or endure) weeks (and often two months) of medical treatment, with each of the sick baby’s feeds requiring medication be administered beforehand to a rigid schedule, milk having to be given slowly and carefully, daily weighing, and regular consultations with the hospital clinic or paediatrician.  Why put yourself through all that when surrendering your baby for just an hour or so to the gowned and skilled surgical staff produces what often seems like an instant fix?

Some babies are best treated surgically, and of the babies treated medically, up to 20% will not respond sufficiently well to avoid belated surgery.

arrogant doc4On the other hand, almost all Ramstedt pyloromyotomies seem to be fully effective, certainly in the immediate sense.  And although the worldwide web includes many thousands of complaints and stories of a long list of troublesome ongoing effects from their PS or its surgery, it is just as clear that the vast majority of survivors and their parents are satisfied enough not to air their troubles.  The possible effects of the surgery are many and real, and sometimes severe, but many PS survivors report little or no gastric or abdominal discomfort, few or no problems with their scar or adhesions, and no trauma.  And this silence of the vast majority of PS patients has enabled most of the medical world to assure anxious and worried parents that “PS and its surgery will have no after-effects on your dear child”.

What I have written so far gives me some cause for concern, however.

Ramstedt’s discovery at once saved my life (and I’ve had more than 70 very good years so far), and it has also been responsible for the trauma I and not a few others have had to deal with (often chiefly in private) for most of our lives.

It was quite unintentional, but it is nevertheless true that Ramstedt’s surgical solution for PS effectively and inexorably moved the medical community’s interest away from perfecting the already (and still today) quite effective treatment of PS with cheap and simple medication and careful maternal nursing.  The Ramstedt pyloromyotomy is (as stated above) in itself what many surgeons call “elegant”: it is easy, quick and usually effective.  But until quite recently the surgery and what came with it could be very severe and traumatic on the baby and also on the parents, and it was associated with more (and more severe) risk factors than the medical alternative.

Thus the Ramstedt pyloromyotomy helped fuel the ascendancy of the power and prestige of the surgeon with which some of us are all too familiar today!  We must remember that specialist and high technology medical science has been very largely responsible for our rising health standards and life expectancies, but in fact PS is one of the maladies that can in most cases be brought under control by medical means and with surgery kept as a last resort.  In some developed countries, PS continues to be managed in this manner, and in many developing countries, medical treatment is far more affordable and widely available, and thus the first option.

So Ramstedt’s operation short-circuited interest in understanding and managing the causes, pathogenesis (biochemical development such as proposed by Dr Ian M Rogers) and even prevention of PS.

Whilst I am deeply grateful for the operation that saved my life and realise that in my case surgery may well have been the only responsible remedy, I have often wished that I could have been treated more gently, without a disfiguring scar, and without inflicting life-long trauma on my parents and me.

And in this wish I am not alone.

Immediate hazards after Pyloric Stenosis

Parents - worry01Having your new baby go through surgery, however “minor” in the eyes of the medical world, is always harrowing for the parents.  Those who have written about this will almost always say it was their most traumatic time ever, and some continue to suffer post-traumatic stress.

Remember that this surgery almost always follows a period of your infant being sick and steadily losing condition, followed by what may be a deeply upsetting period of doctor visits, medical tests, specialist consultations, and typical hospital admission procedures – with baby’s condition steadily going downhill…

Remember also that doctors are human: far too many treat their fragile patients and parents poorly, and diagnosis is too often avoided or faulty, too often ending only at a near-terminal crisis.  All this adds to the stress and strain.

Add to this that surgery for infant pyloric stenosis (“PS”) surgery is often promised to be a “quick fix”.  Although many of these little patients do recover promptly and quickly more than catch up on their weight loss, other PS babies take months or even years to find their balance – and some few never do.

Add to this that many surgeons seem to regard their responsibilities as ending when they leave the operating room, and that many GPs simply don’t engage with parents who have a baby with a feeding problem.

What are the main problems parents may have to manage after PS surgery? Continue reading “Immediate hazards after Pyloric Stenosis”

Infant pyloric stenosis – and its possible long-term effects

For almost two years I have been posting weekly about infant pyloric stenosis (“PS”) and I am grateful to the readers who have given me the valued feedback that they appreciate my solid research and lucid and careful writing.

WordPress (which hosts my blogsite) also gives me feedback, and it’s not surprising that the top number of searches here have been for information about the long-term effects of PS and the surgery for it.  Using the Search box (top right on this page) will allow you to read all my blogs on this subject – but to overview and add to this material, please read on…

The long-term effects of severe PS

Studies have shown that the severe malnutrition of a baby which is far too common before PS is diagnosed and treated can affect its memory and the development of its motor skills and coordination.  A link with Continue reading “Infant pyloric stenosis – and its possible long-term effects”

An abdominal scar and pregnancy

I have a surgical scar on my stomach: how will this affect me during my pregnancy?

This reasonable and very understandable concern affects many people – and there are many women who very much want a child despite uncertainty caused by having had an abdominal operation.

Why should I, a male and not a professional medical worker, be writing about this?

Being male I am very hesitant to address this question – so here’s why I’m posting this… Continue reading “An abdominal scar and pregnancy”

Long-term hazards

When your baby had infant pyloric stenosis (“PS”), the surgery marked the end of a difficult time for you and your newborn treasure… Right?

If that’s true of you as parents or you as the baby, you belong to the truly blessed ones – at least in this respect!

Patient & doctor01Most doctors and websites tell the parents that there are no long-term problems after PS and its surgery (pyloromyotomy).  Only a minority of the websites I have seen are a little more careful, assuring us that “most” babies will have no more problems.  None go into detail about that “most”.

In 20 years of trawling the web I have yet to find Continue reading “Long-term hazards”

Scars that strangle

Readers of this post may well know what adhesions are, but just to be sure, let’s start at the very beginning…

What are adhesions?

Adhesions are bands and webs of tough, fibrous and inelastic scar tissue which develop after tissue damage resulting from injury, surgery, an internal infection, endometriosis, some chemotherapy, or radiation therapy.  They can affect the functioning of muscles, joints, and ligaments, but cause most problems in the abdomen and chest where they can grow between our organs and the abdominal wall, or restrict the movement and work of our organs, causing pain and possibly restricting their function.

Adhesiolysis01.jpgAbout 10% of all people develop adhesions naturally (without surgical or other damage), but it is estimated that they occur in over 90% of people who have abdominal or chest surgery – which means many of us! So we may be thankful that they cause significant problems for only a minority – but that’s small comfort if you belong to that minority.

These problems range from unsightly sunken scars and pain to life-threatening abdominal blockages.  Adhesions cause 60 – 70% of small (upper) bowel obstructions in adults and can be the cause of chronic pelvic pain.

Some of us who have had infant surgery for infant pyloric stenosis, or for that matter any of a list of the diseases of the abdomen and chest may find that Continue reading “Scars that strangle”