Because of the proposal that infants with hypertrophic pyloric stenosis should only be treated by surgeons with an interest in paediatric surgery, we carried out a retrospective study to audit our experience in a district general hospital. Forty six infants over a five year period underwent pyloromyotomy. There were no deaths, and 36 infants (78%) made uneventful recoveries. Perforation of the duodenal mucosa occurred during the operation in 11 patients, and eight complications developed in six of these infants. There were seven wound infections, and two patients had vomiting that lasted four days or longer after their operations. There were no long term feeding problems.The results of this study show that such patients can be successfully treated in district general hospitals, and three areas merit special attention: meticulous surgical technique, the use of prophylactic antibiotics, and early graduated feeding.In a recent report from a regional centre in London, it was suggested that infants being treated in a district general hospital for hypertrophic pyloric stenosis should instead be treated by surgeons with a special interest in paediatric surgery.' An earlier study from a district general hospital in England was cited, and the proposal was made because of the high complication rate.2 These prompted the present retrospective study: our aims were, firstly, to audit our own experience at a district general hospital in treating infants with pyloric stenosis, and, secondly, to propose any necessary changes in management so that such patients may be successfullly treated by general surgeons in district general hospitals.

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side of the bed, insertion of a percutaneous endoscopic gastrostomy tube will not necessarily prevent this as these tubes may themselves be pulled out by a determined patient-indeed, some authorities believe that psychosis and dementia are relative contraindications to insertion.8 Thus percutaneous endoscopic gastrostomy is not the end of the line for nasogastric feeding but an example of one of several useful techniques that may be considered for long term enteral feeding. Nasoenteral tubes will continue to provide the main route of access for most patients requiring enteral nutrition.

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