The book starts by a relevant story of Frederick Vanderborn who had infantile hypertrophic pyloric stenosis (IHPS) as a baby and had a successful surgery at a time around the end of the Second World War. Despite successful surgery, Dr. Vanderborn suffered from the appearance of the scar which prevented him from joining many activities, sports, and physical education at school, he felt himself different. A fact often overlooked by surgeons performing successful surgery.

Despite the early description of time-honored surgical treatment by Ramstedt, in 1912, the real mechanisms underlying its development remain speculative. Ian Rogers forwards the theory of constitutional hyperacidity as a stimulus to increased workload of the pylorus as a causative mechanism. Dr. Rogers puts very convincing evidence about the theory in a logic and sequential manner.

Dr. Rogers answers very important questions based on his solid theory, why male babies? Why 1st born? Why selfcure? Among other questions, all very explained and well documented. The relative insensitivity of the gastrin/gastric acidity feedback plays a central role in the causation of pyloric stenosis as high levels of gastric acidity in some neonates will induce more workload for the pylorus moving from pylorospasm to pyloric hypertrophy, then finally ending up in pyloric stenosis.

If hyperacidity and excess gastrin are the prime mechanism, then why not use medical treatment in some selected cases and avoid the risk of surgery and psychological problems of the scar, Dr. Rogers is offering this option in some selected cases to save them from unnecessary surgery.

Pediatricians and pediatric surgeons with interest in IHPS should read this book, which combines history, emotion, with convincing scientific evidence.