Umbilical pyloromyotomy--an alternative to laparoscopy?
OBJECTIVE
To evaluate the utility of umbilical pyloromyotomy for infantile hypertrophic pyloric stenosis (IHPS) compared to published series promoting laparoscopy.


METHODS
Eighty-six babies with IHPS had pyloromyotomy using an umbilical skin fold incision. Operating times, post-operative hospital stay and cosmetic appearance of the umbilical wound were studied. Data extracted from recent series promoting laparoscopy were identified using a MEDLINE search strategy and used for comparative analysis.


RESULTS
Mean operating time for umbilical pyloromyotomy was 30 min (range 15-50 min). All patients went home at an average period of 58 h (range 48-72 h) following surgery. The umbilical scar was barely visible in the post-operative period. Laparoscopic pyloromyotomy operating times ranging from 18-41 min (mean overall 30 min) are recorded in the literature. Post-operative stay following laparoscopy has been variable (23-91 h), where reported. In contrast with umbilical pyloromyotomy, "pox" marks observed following port insertions for laparoscopy can give an unsightly scar.


CONCLUSIONS
This study has found that umbilical pyloromyotomy can be performed with minimal morbidity and equivalent operating times to laparoscopy. The shorter hospital stay reported in some series promoting laparoscopy must be balanced against local practice influencing hospital stay, the financial implications of offering a laparoscopic service, the skills needed for laparoscopy, and the short learning curve required by paediatric surgical trainees to become proficient at umbilical pyloromyotomy. The cosmesis of the umbilical incision is excellent. These findings suggest that umbilical pyloromyotomy is a reliable alternative to laparoscopy.
Shankar
K R
KR
Department of Paediatric Surgery, Institute of Child Health, Alder Hey Children's Hospital, The University of Liverpool, UK.
Losty
P D
PD
Jones
M O
MO
Turnock
R R
RR
Lamont
G L
GL
Lloyd
D A
DA
D006801:Humans; D006984:Hypertrophy; D007223:Infant; D007231:Infant, Newborn; D010535:Laparoscopy; D011707:Pyloric Stenosis / Q000601:surgery*; D016896:Treatment Outcome