Ramstedt Operation

Description

Surgical correction of hypertrophic pyloric stenosis, involving longitudinal splitting of the hypertrophic pylorus and leaving the defect open. This is in contrast to previous procedures which involved closure of the muscle.

History

Pyloric Stenosis:

  • 1627Fabricius Hildanus wrote “...a small, wasted, six months child, the eldest son of Henry Otho, Esq. This child’s stomach had been, for days, crammed by the nurse or mother with a thick and viscid pultraceous feed…since he was vomiting up everything given by the mouth and was passing nothing through the lower passages, I prescribed one or two nutrient enemata for every day, made from broth to which was added the yolk of an egg and a small quantity of mixed sugars…now perfectly well. Not every obstruction, therefore, of the lower orifice of the stomach is to be considered incurable” [Observatio singularis de obstructione pylori XXXIV]
  • 1717 – Patrick Blair (1665-1728) reported to the Royal Society the clinical history and autopsy report of a 5-month-old boy with pyloric stenosis. “…The Pylorus, and almost half of the Duodenum were cartilaginous, and something inclin’d to an Ossification, so that no Nourishment could have passed into the Intestines, tho’ the Stomach had been capable of containing it, which makes it no wonder that the Body was so emaciated...” [An Account of the Dissection of a Child]
  • Further autopsy and clinical accounts including George Armstrong (1777); Hezekiah Beardsley (1787)
  • 1888Harald Hirschsprung provided the most definitive description in the autopsy findings in two infants [1888; 28: 61-68] “…I thought it would be of interest to present to the Society two cases of undoubted congenital pyloric stenosis in nurslings. A third case (chronologically be considered in this report since the not been preserved
  • 1910 – Case reports rapidly grew to 600 in conjunction with epidemiological studies and alternate operative approaches to arrest the associated high infant mortality.

Early Management: – Late 1800’s Medical versus Surgical Medical approach (believing ‘spasm’ caused ‘hypertrophy’).

  • Relieve spasm with antispasmodic drugs (e.g. belladonna, cocaine, atropine)
  • Remove gastric acid (believed to cause spasm) with frequent bicarbonate gastric lavages
  • Maintain diet with iced milk and thickened feeds
  • Maintain nutrients with nutrient milk/saline enemas

Surgical approach (believing congenital hypertrophy was the root of the problem)

  • 1898 – Karl Löbker (1854-1912) performed gastro-enterostomy. (7 operations, three deaths)
  • 1889 – James Nicholl – divulsion of the pylorus (Loreta’s operation) using a mechanical dilator introduced through the stomach. (9 operations, 3 deaths)
  • 1902 – Clinton Dent complete pyloroplasty with longitudinal incision extending through all the layers of the pylorus, including the mucosa, was converted into a transverse one with 75% success rate

Pyloromyotomy

  • 1907 – Pierre Frédet is widely credited as performing the first “extramucosal pyloroplasty” on October 12, 1907 in which the mucosa was left intact during division of the pyloric muscle [1907; 24(2): 1221-1228]
  • 1910 – Sir Harold Stiles (1863–1946) performed the first recorded pylorotomy for pyloric stenosis on February 3 1910 at the Royal Hospital for Sick Children, Edinburgh. Although he did not publish the case, the Operation Note remains.
  • 1911 – Ramstedt performed his operation 17 months later on the 28 July 1911 and published in 1912

Opération imaginée par Frédet 1910, pratiquée par Ramstedt 1912.

Marfan 1923

Associated Persons


Alternative names

  • Ramstedt’s Pyloromyotomy
  • Ramstedt’s operation
  • Frédet-Rammstedt operation (Marfan 1923)

References


eponymictionary CTA 2

eponymictionary

medical etymology

Dr Chloe Roy MBChB, BMed Sci (hons). Surgeon in the making | LinkedIn |

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