Pyloromyotomy through an Infraumbilical Incision: Open Technique and Superb Cosmesis

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

References

• 1 Alain J L, Grousseau D, Terrier G. Extramucosal pyloromyotomy by laparoscopy.  Surg Endosc. 1991;  5 174-175
• 2 Blumer R ME, Hessel N S, van Baren R. et al . Comparison between umbilical and transverse right upper abdominal incisions for pyloromyotomy.  J Pediatr Surg. 2004;  39 1091-1093
• 3 Campbell B T, McLean K, Barnhart D C. et al . A comparison of laparoscopic and open pyloromyotomy at a teaching hospital.  J Pediatr Surg. 2002;  37 1068-1071
• 4 Campbell B T, McVay M R, Lerer T J. et al . Ghosts in the machine: a multi-institutional comparison of laparoscopic and open pyloromyotomy.  J Pediatr Surg. 2007;  42 2026-2029
• 5 Ford W DA, Crameri J A, Holland A JA. The learning curve for laparoscopic pyloromyotomy.  J Pediatr Surg. 1997;  32 552-554
• 6 Gauderer M WL. Experience with a nonlaparoscopic, transumbilical, intracavitary pyloromyotomy.  J Pediatr Surg. 2008;  43 884-888
• 7 Greason K L, Allshouse M J, Thompson W MR. et al . A prospective, randomized evaluation of laparoscopic versus open pyloromyotomy in the treatment of infantile hypertrophic pyloric stenosis.  Pediatr Endosurg Innov Tech. 1997;  1 175-179
• 8 Hall N J, van der Zee J, Tan H L. et al . Meta-analysis of laparoscopic versus open pyloromyotomy.  Ann Surg. 2004;  240 774-778
• 9 Kim S S, Lau S T, Lee S L. et al . Pyloromyotomy: a comparison of laparoscopic, circumumbilical, and right upper quadrant operative techniques.  J Am Coll Surg. 2005;  201 66-70
• 10 Ladd A P, Nemeth S A, Kirinchich A N. et al . Supraumbilical pyloromyotomy: a unique indication for antimicrobial prophylaxis.  J Pediatr Surg. 2005;  40 974-977
• 11 Leclair M-D, Plattner V, Mirallie E. et al . Laparoscopic pyloromyotomy for hypertrophic pyloric stenosis: a prospective, randomized controlled trial.  J Pediatr Surg. 2007;  42 692-698
• 12 Ramstedt C. Zur Operation der angeborenen Pylorusstenose.  Med Klin. 1912;  8 1702-1705
• 13 Rickham P P. Congenital pyloric stenosis. Rickham PP, Johnston JH, eds. Neonatal surgery. London; Butterworths 1940: 271-283
• 14 Robertson D E. Congenital pyloric stenosis.  Ann Surg. 1940;  112 687-699
• 15 Sitsen E, Bax N MA, van der Zee D C. Is laparoscopic pyloromyotomy superior to open surgery?.  Surg Endosc. 1998;  12 813-815
• 16 Peter St SD, Holcomb G W, Calkins C M. et al . Open versus laparoscopic pyloromyotomy for pyloric stenosis: a prospective, randomized trial.  Ann Surg. 2006;  244 363-370
• 17 Tan K C, Bianchi A. Circumumbilical incision for pyloromyotomy.  Br J Surg. 1986;  73 399
• 18 Taqi E, Boutros J, Emil S. et al . Evaluation of surgical approaches to pyloromyotomy: a single center experience.  J Pediatr Surg. 2007;  42 865-868