Infantile hypertrophic pyloric stenosis (IHPS) is most common surgical cause of non-bilious vomiting in infants. This study describes the clinical presentation, diagnosis, management and outcome of management of infants with IHPS and identifies the factors responsible for poor outcome in these patients. Methods and Materials: This is a prospective study. It was conducted between September 2018 to April 2020 at J. K. Lone Hospital, SMS Medical College Jaipur, and Rajasthan, India. Results: A total 80 patients (M: F=4.7:1) were studied with male predominance. Mean age of presentation was 6.26 weeks. Maximum 47.5% (38) patients present in age group of >4-8 weeks. Clinical presentation with a triad of non-bilious projectile vomiting, visible gastric peristalsis and palpable Olive tumor was present in 62.5 % (50) patients. Non bilious vomiting was the most common presenting symptom, present in 100% (80) patients. Mean hospital stay was 4.23 days. Serum electrolytes disturbance was present in 61.5% (49) patients. The surgery was Ramstedt's pyloromyotomy done in all cases. Mortality rate was 3.75%.Thickness of pyloric muscles was increasing in proportional ratio with age. Conclusion: In this study delayed presentation and Serum electrolytes imbalance are most common causes of poor outcome. USG abdomen is best imaging modality for confirmation of diagnosis. Pyloric muscle wall thickness showed relation with age in proportional increasing pattern.

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At 12 months' follow-up 298 of 530 patients (56.2%, 95% CI, 52.0%-60.4%) were pain-free in the restrictive strategy, compared to 321 of 537 patients (59.8%, 95% CI, 55.6%-63.8%) in usual care. Non-inferiority was not demonstrated as the lower limit of 95% confidence interval of pain-free patients exceeds the 5% non-inferiority margin. (pnoninferiority = 0.316). The restrictive strategy resulted in a significantly lower cholecystectomy rate than usual care (67.7% versus 75.4%, p=0.005). Other secondary outcomes were comparable between groups: median time to pain-free (7.87 months versus 7.29 months, p=0.130), patient satisfaction with treatment outcome at 12 months' follow-up (p=0.976), and patients' health status over time (p=0.820). Overall, patients with preoperative biliary colics were more often pain-free after cholecystectomy (65.5% versus 57.4%, p=0.048). Conclusion:The restrictive strategy is associated with less cholecystectomies. However, suboptimal pain reduction in patients with gallstones and abdominal pain is seen in both usual care and following a restrictive strategy for selection for cholecystectomy.