Download PDF
Eur J Pediatr Surg 2009; 19(2): 72-75
DOI: 10.1055/s-2008-1039197
Original Article

© Georg Thieme Verlag KG Stuttgart · New York

Pyloromyotomy through an Infraumbilical Incision: Open Technique and Superb Cosmesis

S. Emil1 , 2
  • 1Division of Pediatric Surgery, Miller Children's Hospital, Long Beach, CA, USA
  • 2University of California, Irvine School of Medicine, Irvine, CA, USA
Further Information

Publication History

received August 18, 2008

accepted after revision October 24, 2008

Publication Date:
17 February 2009 (online)

    Permissions and Reprints

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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 5 Ford W DA, Crameri J A, Holland A JA. The learning curve for laparoscopic pyloromyotomy.  J Pediatr Surg. 1997;  32 552-554
    CrossrefPubMedGoogle Scholar
  • 6 Gauderer M WL. Experience with a nonlaparoscopic, transumbilical, intracavitary pyloromyotomy.  J Pediatr Surg. 2008;  43 884-888
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 12 Ramstedt C. Zur Operation der angeborenen Pylorusstenose.  Med Klin. 1912;  8 1702-1705
    PubMedGoogle Scholar
  • 13 Rickham P P. Congenital pyloric stenosis. Rickham PP, Johnston JH, eds. Neonatal surgery. London; Butterworths 1940: 271-283
    Google Scholar
  • 14 Robertson D E. Congenital pyloric stenosis.  Ann Surg. 1940;  112 687-699
    PubMedGoogle Scholar
  • 15 Sitsen E, Bax N MA, van der Zee D C. Is laparoscopic pyloromyotomy superior to open surgery?.  Surg Endosc. 1998;  12 813-815
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 17 Tan K C, Bianchi A. Circumumbilical incision for pyloromyotomy.  Br J Surg. 1986;  73 399
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

MD, CM Sherif Emil

Montreal Children's Hospital

2300 Tupper, C-818

Montreal, QC, H3H 1P3

Canada

Email: sherif.emil@muhc.mcgill.ca

      >