Pyloric stenosis surgery makes a century! (1) – enter Dr Conrad Ramstedt

Pyloric Stenosis would most likely have robbed me of life less than two weeks after my birth if I had been born just a third of a century before I was.

Dr Conrad Ramstedt (1867-1963)

It was in September and October 1912 that a German military surgeon first shared with the medical world his discovery of a quick, simple and effective surgical remedy for Pyloric Stenosis (“PS”).  I was born exactly 33 years later, by which time Dr Conrad Ramstedt’s surgical technique had become almost universally adopted.  What has become known as the Fredet-Ramstedt Pyloromyotomy was published in a German medical journal dated 20 October 1912. *

So while the world has been marking the centenary of the Titanic’s maiden voyage and tragic loss, of British explorer Robert Falcon Scott’s successful but ill-fated expedition to the South Pole, of the first parachute jump from an aircraft, the patenting of stainless steel, the identification of vitamins, and of the formation of the Republic of China, the international Scout and Guide movements and the African National Congress, there are millions like myself for whom the centenary of Ramstedt’s pyloromyotomy operation is far more significant in 2012 – although most of us PS survivors probably don’t realise it.

I have posted earlier that although PS had been recognised since 1627, it was not until the late 19th century that surgical remedies began to be attempted.  But neither the medical nor surgical treatment did much to reduce an appalling death rate.  The several surgical techniques suggested around 1900 were severe, involved mortality rates well over 60% and were rejected by most parents and doctors.  The death-rate of PS treated conservatively (by small feeds, stomach washes, medication and attempts to stretch the pyloric passage) was then between 10 and 46% at the time.

In 1908 the French surgeons H. Doufour and Pierre Fredet published the description of their new PS operation, “extramucosal pyloroplasty”, which had given better results: they split the pyloric muscle lengthwise down to the mucosa (the passage’s inner lining was left intact) and then stitched it to make the incision cross the muscle.  In their own words –

Diagram of a Heinicke-Alikulicz pyloroplasty

“Incision of about two centimetres in the axis of the pylorus, on the middle of the anterior surface.  This longitudinal incision goes through the peritoneum and muscularis but excludes the mucosa.  The bistoury [a long, narrow surgical knife for minor incisions] cuts a tissue which is white, mottled, bloodless, very hard, squeaking under the instrument, having the same appearance as certain uterine myomas.  The incision thus divides the sphincter for some millimetres in depth (more than five certainly) and the lips of the wound part voluntarily.  A series of linen sutures are placed as in the procedure of Heinicke-Alikulicz, transforming the longitudinal wound into a transverse wound, an autoplasty [a repair using only that body part] which manifestly enlarges the pylorus.”

As I have written elsewhere, after doing two Fredet pyloroplasty operations Dr Conrad Ramstedt discovered accidentally that it was unnecessary to stitch the pylorus to reshape the split.  It is appropriate to read about this in his own words –

Four stages of a Ramstedt pyloromyotomy

“An incision five centimetres long opens the abdomen in the mid-line at the level of the pylorus.  The stomach is enormously dilated.  The pylorus is thicker than a thumb, cylindrical in shape, glistening reddish-white, hard as cartilage.  Division of the thickened muscles on the anterior surface of the pylorus; only one circular suture at the point of change from pylorus to duodenum was necessary.  The incision gaped widely and was left uncovered.  Pylorus replaced, abdominal wall closed.  Plaster bandage.  Duration of the operation fifteen minutes.  Ether narcosis.”

YouTube offers several videos that show how a Ramstedt pyloromyotomy is performed, nowadays with laparoscopy (keyhole surgery); be aware that these videos are graphic!

The Ramstedt operation for pyloric stenosis involves splitting the hypertrophied (enlarged) muscle down to the mucosa (inner lining of the gastric passage), forcing and then leaving the cut to gape open (lengthwise), and then closing the abdomen.  This technique was discovered by Dr Ramstedt by accident followed by good observation, and it remains the essential element of the operation today, although there have been several ways of gaining access to a pesky problematic pylorus.

One of Conrad Ramstedt’s colleagues made a prediction in the early 1920s, when he introduced Ramstedt to his students: „Von diesem Mann werden Sie einmal mehr hören als die heutigen Pädiater und Chirurgen ahnen.“ – “One day you will be hearing more about this man than our current pediatricians and surgeons can possibly imagine at present.”

How right that was!

____________________________________________________________________

*  In researching for this post I was frustrated and annoyed.  I found that not only ground-breaking and research-based medical articles are locked up in high-cost medical journals – that is reasonable and understandable.  However, several journal articles have marked the centenary of Dr Ramstedt’s pyloromyotomy with historical and celebratory articles which would be of no monetary value to anybody; others are a century old and of historical value only.  But all of the former and many of the latter are only available to well-heeled subscribers or to grateful and interested survivors like me at a cost of over US$30 per item.  Having worked for the welfare of others as a Christian pastor all my life I sometimes wonder how others who have also committed to a life of service can sleep at night. 

And, this post about 100 years of Ramstedt pyloromyotomies is also my 100th SIS post.  I am grateful for well over 20,000 reader “hits” and so much appreciative, interesting and encouraging response. 

Advertisements

8 thoughts on “Pyloric stenosis surgery makes a century! (1) – enter Dr Conrad Ramstedt

  1. Wendy Patrice Willliams

    Thank you, Fred, for soldiering on and celebrating the life of this great man who, in a way, is responsible for us meeting and befriending one another. How frustrating to be kept from information that would help so many of us. Also, congrats on the great images you find to clarify this whole PS thing. (I’m gathering courage to watch the video.) Without the graphics, PS is difficult to picture. Wow, 100 years! So many have died from PS, yet here we are. Thank you for your continued dedication (100 posts!) to the issue and to PS survivors and their families all over the world.

    Reply
  2. Fred Vanderbom Post author

    Isn’t it weird how the man who more than anybody I can think of was responsible for our being alive, productive and good friends also created the possibility of the trauma which we and many others have struggled all our lives to overcome! I want to write about this in my next post.
    Although I also learnt the word “pylorospamus” (which is what the Dutch will often call the condition we had) from quite an early age, I never knew what that term meant until years later; it then came to mean “uncontrollable vomiting”, and home medical manuals said little more about it. It took the internet to allow me to see and understand what the condition involved and how surgery dealt with it.
    With you I’m glad I’ve been able to help many PS survivors and their parents, as well as other affected by the trauma that can come with infant surgery.

    Reply
  3. Sandra

    Conrad Ramstedt was my grandfather. I was only 3 when he died and I didn’t live in Germany so I never even got to meet him… Thank you for writing such an interesting article about him! I’m so proud that his operation saved so many little ones.

    Reply
  4. Fred Vanderbom

    Sandra, I’m so glad that you found this post and appreciated what I was able to write about your grandfather!
    I’ve read several of the German and English language websites that mention his work – and it’s always with deep respect and appreciation. I find that Dr Ramstedt’s passion and integrity are clear in that he continued to gather information about PS and the effectiveness of the different ways it was treated after his special contribution – and to publish his findings so openly.
    You have much reason to feel proud – and I to be thankful.

    Reply
  5. Thomas Charron

    It’s heart pulling to read some of the stories of ps survivors and what their families went through and what a lot of families are going through still to this day. I myself am a ps survivor from 1962, born in a small town of Brockville Ontario. My grandmother told me from day one I was the center of attention because they had never seen a baby who threw up everything. They had no idea what was wrong but they knew it was something serious. I was kept in the hospital hooked up to all kinds of things to keep me going and watched 24-7. By the second week they were pulling resources from everywhere, calling in doctors from whereever they could because time was not on my side. They thought they were going to lose me, but by the middle of the third week I was on the operating table diagnosed with ps. Surgery was a success and I have never had any stomach problems or digestive issues my whole life, now soon to be 54. My prayers go out to all survivors and families that have gone through this or who are going through it now. And my heart goes to all the medical staff who took 3 weeks out of their lives to make sure my life could go on 🙏❤️

    Reply
    1. Fred Vanderbom Post author

      Thank you for adding your story here, Thomas. Despite what will no doubt have been some very stressful things for all involved at the time, your life was saved and you have voyaged since without long-term damage. That seems to be the way for the majority, but even your “majority” story has made you more aware and understanding of what can go wrong. Best wishes!

      Reply
  6. T.A.

    When recently reading about PS an article mentioned that a stent was used in operations to open the pyloric sphincter muscle… anyone here heard of that?

    I had PS as a baby was operated on at six weeks.

    Am curious about this stent comment but been unable to find the original article.

    Reply
    1. Fred Vanderbom Post author

      I really hope some of our readers here can post about having had this treatment, either for their little one or as an adult with PS. It surprises me that in all my reading over many years I’ve never found this simple and obvious remedy mentioned. T.A., I’ll post your Comment on the Facebook P S Support Group’s page in the hope of getting some more light.

      Reply

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s