Efficacy of Umbilical Sliding Window Method for Treating Remnant Hypertrophic Pyloric Stenosis After Pyloromyotomy Using Tan-Bianchi Method

Abstract

Ramstedt’s pyloromyotomy is generally useful for the successful release of gastric obstruction in most cases of infantile hypertrophic pyloric stenosis (HPS). However, in rare cases, repyloromyotomy is necessary to treat postoperative remnant pyloric stenosis. Repyloromyotomy by the same method as the first pyloromyotomy using the popular Tan-Bianchi (TB) method is risky owing to scarring or adhesion of the operating field. The umbilical sliding window (USW) method for repyloromyotomy reduces the risk of intra-abdominal injury associated with reoperation. A 7-month-old boy after pyloromyotomy using the TB method suffered from prolonged nonbilious vomiting. An upper gastrointestinal examination showed difficulty in passage of the contrast medium through the pylorus, and ultrasonography revealed a hypertrophic pyloric muscular layer. We performed repyloromyotomy using the USW method to treat his remnant pyloric stenosis. His postoperative course was uneventful with a good outcome cosmetically.