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Pyloromyotomy through circumbilical incision with fascial extension
V Karri1, N Bouhadiba, A B Mathur
1Department of Paediatric Surgery, Jenny Lind Children's Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, Norfolk, NR4 7UY UK.
Insights
This study modified the Ramstedt
Area of Science:
- Pediatric Surgery
- Surgical Techniques
- Gastrointestinal Surgery
Background:
- Pyloric stenosis is a common cause of non-bilious vomiting in infants.
- Ramstedt's pyloromyotomy is the standard surgical treatment.
- The circumbilical approach offers cosmetic advantages but can limit tumor delivery.
Purpose of the Study:
- To evaluate the efficacy and safety of an 'inverted T' fascial incision modification for the circumbilical approach in Ramstedt's pyloromyotomy.
- To assess operative time, complication rates, and cosmetic outcomes.
Main Methods:
- A modified circumbilical approach with an 'inverted T' fascial incision was used in 51 infants with pyloric stenosis.
- Pyloric tumor delivery, operative time, wound complications, and incisional hernia were assessed.
- Follow-up was conducted at 3 months post-surgery.
Main Results:
- The 'inverted T' modification facilitated easy delivery of pyloric tumors of all sizes.
- Mean operative time was 31.4 minutes.
- A low rate of mild wound infection (3.9%) was observed, with no incisional hernias at 3-month follow-up.
Conclusions:
- The 'inverted T' fascial incision modification enhances the circumbilical approach for Ramstedt's pyloromyotomy.
- This technique is safe, efficient, and yields excellent cosmetic results with minimal complications.
Abstract:
Extending the fascial incision underlying the circumbilical approach to the shape of an 'inverted T' permits easy delivery of the pyloric tumour for Ramstedt's pyloromyotomy. This modification was used in 51 consecutive infants (42 male, 9 female) with a mean age of 4.7 weeks. Extension of the skin incision or conversion to the right hypochondrium approach was not necessary in any patient and the mean operating time was 31.4 min. Mild wound infection occurred in two infants (3.9%) that resolved with antibiotic treatment. Follow-up at 3 months did not detect any incisional hernia. This modification allows delivery of small or large pyloric tumours, is associated with a low rate of wound infection and does not alter the excellent cosmetic finish.