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Supraumbilical pyloromyotomy: comparison between intracorporeal and extracorporeal approaches
Shigeru Takamizawa1, Masayuki Obatake, Toshihiro Muraji
1Department of Surgery, Kobe Children's Hospital, 1-1-1 Takakuradai, Suma-ku, Kobe 654-0081, Japan. takamizawa_kch@hp.pref.hyogo.jp
Insights
Intracorporeal pyloromyotomy (ICP) offers faster feeding resumption for infants with hypertrophic pyloric stenosis compared to extracorporeal pyloromyotomy (ECP). This minimally invasive approach leads to shorter hospital stays and fewer incision extensions.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Gastrointestinal Surgery
Background:
- Hypertrophic pyloric stenosis (HPS) is a common condition in infants.
- Pyloromyotomy is the standard surgical treatment for HPS.
- Extracorporeal pyloromyotomy (ECP) has been the traditional approach.
Purpose of the Study:
- To evaluate intracorporeal pyloromyotomy (ICP) as a novel alternative to ECP for HPS.
- To compare the outcomes of ICP and ECP in infants with HPS.
Main Methods:
- Retrospective review of medical charts for 75 infants undergoing ICP and 29 undergoing ECP.
- Comparison of operating time, time to full feeding, complications, and outcomes.
- Analysis of incision extension rates and wound infections.
Main Results:
- ICP had a longer operating time (56.4 min) than ECP (48.7 min) (p=.004).
- ICP resulted in significantly faster return to full feeding (2.1 days) versus ECP (2.9 days) (p=.002).
- Fewer incision extensions were needed for ICP (2/75) compared to ECP (11/29) (p<.0001).
Conclusions:
- Intracorporeal pyloromyotomy (ICP) is a superior technique for treating hypertrophic pyloric stenosis.
- ICP facilitates earlier feeding resumption and shorter hospitalizations.
- ICP demonstrates improved outcomes regarding incision extension compared to ECP.
Abstract:
We evaluated intracorporeal pyloromyotomy (ICP) as an alternative to extracorporeal pyloromyotomy (ECP) in infants with hypertrophic pyloric stenosis. From July 1994 to June 2002, 75 patients underwent ICP, and 29 patients underwent ECP through supraumbilical incisions. The medical charts were reviewed retrospectively with regard to operating time, time to return to full feeding, complications, and outcome. The average operating time in the ICP group was significantly longer than in the ECP group (56.4+/-13.6 vs. 48.7+/-16.3 min; p=.004). However, the average time to return to full feeding in the ICP group was significantly shorter than in the ECP group (2.1+/-1.6 vs. 2.9+/-1.9 days; p=.002). Extension of the skin and/or fascial incision was necessary in two of 75 patients in the ICP group, compared with 11 of 29 patients in the ECP group ( p<.0001). There were four (5.3%) wound infections and one (1.3%) mucosal perforation in the ICP group, compared with two (6.9%) wound infections in the ECP group. ICP allows patients to return to full feeding earlier than ECP does, resulting in a shorter hospital stay. ICP through a supraumbilical incision is superior to the ECP technique.