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Comparison between umbilical and right upper transverse abdominal incisions for pyloromyotomy: a systematic review
Hemant Khandelia1, Nellai Krishnan2, Deepika Kainth3
1All India Institute of Medical Sciences, New Delhi, India.
Insights
The right upper quadrant (RUQ) incision for infantile hypertrophic pyloric stenosis (IHPS) surgery has lower operative time and fewer complications than the umbilical (UMB) incision. However, UMB offers a nearly invisible scar, necessitating careful risk-benefit discussion with caregivers.
Area of Science:
- Pediatric Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) requires surgical intervention.
- Ramstedt's pyloromyotomy is a standard treatment for IHPS.
- Surgical incision site choice impacts outcomes and aesthetics.
Purpose of the Study:
- To compare operative parameters and complication rates of umbilical (UMB) versus right upper quadrant (RUQ) skin incisions for Ramstedt's pyloromyotomy in IHPS.
- To evaluate the safety and efficacy of different surgical approaches for IHPS.
Main Methods:
- Systematic literature search of PubMed, EMBASE, Web of Science, and Scopus.
- Inclusion of 15 studies with 2964 infants reporting operative time, wound infection, or mucosal perforation.
- Random-effects model for statistical analysis and Newcastle-Ottawa Scale for quality assessment.
Main Results:
- The RUQ incision group demonstrated significantly lower mean operative time (p=0.0004).
- RUQ incisions resulted in significantly lower wound infection rates (p<0.0001) and mucosal perforation rates (p=0.02) compared to UMB.
- While UMB incisions yield better cosmetic results, they are associated with higher complication rates.
Conclusions:
- The RUQ incision approach for IHPS pyloromyotomy is associated with improved operative efficiency and reduced complication rates compared to the UMB approach.
- Caregivers should be informed about the trade-offs between cosmetic outcomes (UMB) and complication risks (RUQ) when deciding on the surgical approach for IHPS.
- Further high-quality studies are recommended due to the methodological limitations identified in several included studies.
Abstract:
The aim of this study was to compare the operative parameters and complication rates between the umbilical (UMB) and right upper quadrant (RUQ) skin incisions for Ramstedt's pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis (IHPS). PubMed, EMBASE, Web of Science and Scopus databases were systematically searched. The studies where any one of the main outcomes of interest, i.e., operative time, wound infection rate, mucosal perforation rate were reported were eligible for inclusion. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle-Ottawa Scale. Fifteen studies comprising 2964 infants were included. As compared to the UMB group, the RUQ group showed a significantly lower mean operative time (p = 0.0004), wound infection rate (p < 0.0001) and mucosal perforation rate (p = 0.02). Although UMB incision produces an almost undetectable scar, this approach results in significantly more complications. Therefore, the risks and benefits must be weighed and discussed with the caregivers in deciding the surgical approach in patients with IHPS. However, due to a poor methodological quality of nine out of fifteen studies, further studies need to be conducted for an optimal comparison between the two groups.
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