Umbilical pyloromyotomy - An alternative to laparoscopy?

Aims: To evaluate the utility of umbilical pyloromyotomy for infantile hype rtrophic pyloric stenosis (IHPS) compared to published series promoting lap aroscopy. Methods: Eighty-six babies with IHPS had pyloromyotomy using an u mbilical skin fold incision. Operating times, post-operative hospital stay and cosmetic appearance of the umbilical wound were studied. Data extracted from recent series promoting laparoscopy were identified using a MEDLINE s earch strategy and used for comparative analysis. Results: Mean operating t ime for umbilical pyloromyotomy was 30 min (range 15-50 min). All patients went home at an average period of 58 h (range 48-72 h) following surgery. T he umbilical scar was barely visible in the post-operative period. Laparosc opic pyloromyotomy operating times ranging from 18-41 min (mean overall 30 min) are recorded in the literature. Post-operative stay following laparosc opy has been variable (23-91 h), where reported. In contrast with umbilical pyloromyotomy, "pox" marks observed following port insertions for laparosc opy can give an unsightly scar. Conclusions: This study has found that umbi lical pyloromyotomy can be performed with minimal morbidity and equivalent operating times to laparoscopy. The shorter hospital stay reported in some series promoting laparoscopy must be balanced against local practice influe ncing hospital stay, the financial implications of offering a laparoscopic service, the skills needed for laparoscopy, and the short learning curve re quired by paediatric surgical trainees to become proficient at umbilical py loromyotomy. The cosmesis of the umbilical incision is excellent. These fin dings suggest that umbilical pyloromyotomy is a reliable alternative to lap aroscopy.