2001 Volume 51 Issue 5 Pages 295-299
Background and Aim : Traditionally, a right upper-quadrant incision (RUQ) has been used for Ramstedt's pyloromyotomy in patients with hypertrophic pyloric stenosis, but a circumumbilical incision (UMB) was introduced by Tan and Bianchi. This technique produces an undetectable scar after the operation, but some concern exists regarding the safety and morbidity of the myotomy.
Materials and Methods : Since 1997, UMB or RUQ have been performed in 41 patients according to the parents' preference. We reviewed the patients' records to clarify whether or not UMB is superior to RUQ with respect to appearance after the operation and complications. Items examined were patiints' demographics and laboratory data on admission, operative time and the incidence of complications. Results : There was no difference between the UMB and RUQ in patients' demographics or laboratory data. The operative time for the UMB was about twice that for the RUQ. Complications (serosal tear in 5 cases, wound infection in 2 and incomplete myotomy in one) occurred with the UMB, but no complication occurred with the RUQ. Out of 8 sequelae in the UMB, six were associated with a lack of skill in junior pediatric surgeons, and serosal tears occurred when delivering the pyloric mass from the abdominal cavity. All resultant scars were hardly visible in the case of UMB, but were noticeable in the RUQ.
Conclusions : The UMB approach offers a cosmetically superior scar, but is difficult for junior surgeons to perform smoothly. An intraabdominal pyloromyotomy should be carried out if the pyloric mass is not delivered.
