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Umbilical incision for pyloromyotomy
G Podevin1, A Missirlu, S Branchereau
1Service de Chirurgerie Viscérale Pédiatrique, Hôpital Armand Trousseau, Paris, France.
Insights
The umbilical incision for hypertrophic pyloric stenosis surgery offers cosmetic benefits without increasing complications. This approach resulted in similar morbidity but shorter hospital stays compared to the standard right upper quadrant incision.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Gastrointestinal Surgery
Background:
- Hypertrophic pyloric stenosis (HPS) surgery traditionally uses a right upper quadrant (RUQ) incision, leading to cosmetic concerns.
- The umbilical incision (UMB) presents a novel approach to minimize visible scarring in HPS treatment.
Purpose of the Study:
- To compare the morbidity associated with the umbilical incision versus the standard RUQ incision for HPS curative procedures.
- To evaluate the safety and efficacy of the UMB approach in pediatric patients.
Main Methods:
- Retrospective comparison of 118 children who underwent UMB surgery (1992-1994) with 121 children who had RUQ surgery (1989-1991).
- Analysis of demographic data (age, sex, weight, prematurity) and surgical outcomes including operating time, mucosal perforations, postoperative vomiting, wound infections, relapses, and dehiscences.
Main Results:
- Mean operative times were significantly longer for the UMB group (52 min) compared to the RUQ group (38 min) (p < 0.001).
- No significant differences in morbidity were observed between the UMB and RUQ groups, including mucosal perforations, early vomiting, wound infections, relapses, and dehiscences.
- Postoperative hospital stays showed a trend towards being shorter in the UMB group.
Conclusions:
- The umbilical incision is a viable alternative for pyloromyotomy, offering improved cosmesis without compromising patient safety or increasing complication rates.
- Despite a slight increase in operative time, the UMB approach for HPS surgery results in minimal scarring and comparable morbidity to the traditional RUQ incision.
Abstract:
The umbilical incision is a new approach for the curative procedure of hypertrophic pyloric stenosis in order to avoid the cosmetic impairment from the right upper quadrant incision. Our purpose was to evaluate the morbidity of the two approaches. One hundred and eighteen children operated on through an umbilical incision (UMB) from 1992 to 1994 were retrospectively compared with 121 children who underwent standard incision, in the right upper quadrant (RUQ), from 1989 to 1991. The two groups were homogeneous with regard to age, sex ratio, weight, and prematurity rate. Mean operating times were longer in the UMB group (52 [ +/- 14] minutes versus 38 [+/- 14] minutes, p < 0.001, t test). Morbidity was not significantly different with regard to mucosal perforations, vomiting during the first 24 postoperative hours, wound infections, stenosis relapses, and wound dehiscences. Postoperative hospital stays tend to be shorter in the UMB group as compared to the RUQ group. Thus, despite slightly increased mean operating times, the umbilical incision did not modify the morbidity of pyloromyotomy and left an almost undetectable scar.