Intraabdominal pyloromyotomy through the umbilical route: A technical improvement

Background/Purpose: Performing a pyloromyotomy through a supraumbilical ski n fold incision will leave an almost invisible scar and therefore has defin itive cosmetic advantages. This alternative approach may be related to tech nical difficulties in delivering a large pyloric tumor when compared with t he conventional pyloromyotomy through a right upper quadrant incision. Howe ver, in situ (intraabdominal) myotomy can help overcome this inconvenience. Methods: Of 122 cases of infantile hypertrophic pyloric stenosis operated o n between January 1990 and August 1996, 29 underwent a pyloromyotomy perfor med intraabdominally through the umbilical route. The medical records of th ese babies were reviewed. Results: Twenty-three boys and six girls (median age, 30 days; range, 17 to 70 days) underwent surgery. The median hospital stay was 2.5 days. There w ere two intraoperative technical complications (small mucosal perforation) and one postoperative wound complication (abcess formation) requiring local drainage. Conclusions: in situ pyloromyotomy through the umbilical route is an elegan t alternative in cases of a large pyloric tumor. J Pediatr Surg 33:1806-180 7. Copyright (C) 1998 by W.B. Saunders Company.