Circumumbilical pyloromyotomy has been used widely to offer an optimum cosm
etic approach. On occasion, there are difficulties in delivering the large
pyloric tumour through a relatively small incision. The authors prospective
ly collected a series of 39 consecutive pyloromyotomies performed over a pe
riod of 3 years in three teaching hospitals. Patients were aged 13 to 90 da
ys (average 35) and the male-female ratio was 5:1. The initial operative ap
proach was a right upper quadrant (RUQ) incision (n = 6) and later a circum
umbilical incision (CUI), with or without lateral extension, combined with
transverse division of the linea alba and part of both rectus muscles (n =
33). Two infants (1 RUQ and 1 CUI) developed wound infections, which were t
reated with antibiotics. There were no other peri- or postoperative complic
ations. It was necessary to extend the incision in one-third of CUI cases (
n = 12) in order to facilitate the delivery of a large pyloric tumour throu
gh the incision. Both omega-shaped (n = 3) and a new modified extension (n
= 9) have been used with good cosmetic results.