Pyloromyotomy through an infra-umbilical incision: open technique and superb cosmesis

The optimal incision for pyloromyotomy remains controversial.

A new pyloromyotomy incision has been developed. The incision is placed circumferentially in the infra-umbilical crease, and accesses the pylorus after dividing the umbilical stalk and enlarging the natural umbilical defect. After the pyloromyotomy, the fascia is closed, simultaneously repairing any concomitant umbilical hernia. Patients were followed up at 2 weeks and at three months after operation. The results of the first 14 consecutive operations over a 5-month period by, or under the supervision of, one staff surgeon are reported.

All 14 pyloromyotomy were successfully completed through the infra-umbilical incision. The series included 4 patients with metabolic alkalosis requiring preoperative correction. One duodenal perforation was recognized and repaired. Mean age and weight of the patients was 31.2 days (range 13-55), and 3 754 g (range 2,880-5,400), respectively. Mean operation time was 28.4 minutes (range 17-46). Mean duration between operation and discharge was 1.93 days (range 1-6), and mean total hospital stay was 2.8 days (range 1-8). There were no immediate or delayed wound complications. A virtually scarless appearance was seen in all patients on follow-up.

A new infra-umbilical pyloromyotomy combines the benefits of the laparoscopic and open approaches and results in superb cosmesis.