Abstract
Background: The optimal incision for pyloromyotomy remains controversial. Methods: A new pyloromyotomy incision has been developed. The incision is placed circumferentially
in the infraumbilical crease, and accesses the pylorus after dividing the umbilical
stalk and enlarging the natural umbilical defect. After the pyloromyotomy, the fascia
is closed, simultaneously repairing any concomitant umbilical hernia. Patients were
followed up at 2 weeks and at three months after operation. The results of the first
14 consecutive operations over a 5-month period by, or under the supervision of, one
staff surgeon are reported. Results: All 14 pyloromyotomies were successfully completed through the infraumbilical incision.
The series included 4 patients with metabolic alkalosis requiring preoperative correction.
One duodenal perforation was recognized and repaired. Mean age and weight of the patients
was 31.2 days (range 13–55), and 3 754 g (range 2 880–5 400), respectively. Mean operation
time was 28.4 minutes (range 17–46). Mean duration between operation and discharge
was 1.93 days (range 1–6), and mean total hospital stay was 2.8 days (range 1–8).
There were no immediate or delayed wound complications. A virtually scarless appearance
was seen in all patients on follow-up. Conclusions: A new infraumbilical pyloromyotomy combines the benefits of the laparoscopic and
open approaches and results in superb cosmesis.
Key words
pyloric stenosis - umbilical - pyloromyotomy - cosmesis
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MD, CM Sherif Emil
Montreal Children's Hospital
2300 Tupper, C-818
Montreal, QC, H3H 1P3
Canada
eMail: sherif.emil@muhc.mcgill.ca
