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.