title: Comparison between umbilical and transverse right upper abdominal incision for pyloromyotomy.
abstract: BACKGROUND
  Besides laparoscopic pyloromyotomy, the operation for pyloric stenosis has been performed using 2 standard open surgical exposures: the right upper quadrant (RUQ) incision and the semi-circumumbilical (UMB) incision. The aim of this study was to compare the morbidity and cosmetic results of both open exposures.
  
  
  METHODS
  Between 1990 and 1995, we performed 104 pyloromyotomies through a RUQ incision. These operations were retrospectively compared with 133 UMB incisions performed between 1995 and 1999.
  
  
  RESULTS
  There were no significant differences between the 2 groups regarding age at presentation, sex, and preoperative status. Only a significantly higher percentage of patients with a metabolic alkalosis before surgery was found in the UMB group, but this did not affect morbidity rate. The groups did not differ significantly with respect to mucosal perforations (P =.95), wound infections (P =.53), inadequate pyloromyotomies (P =.42), or other complications. The mean operating time was slightly longer in the UMB group (P <.025). The UMB approach produced a better cosmetic result, with an almost invisible scar.
  
  
  CONCLUSIONS
  This study has shown that the UMB approach has equal intra- and postoperative complication rates as compared with the RUQ approach. The main advantage of the UMB approach is that it produces an excellent long-term cosmetic result.
authors.affiliation: Pediatric Surgical Centre of Amsterdam, Emma Children's Hospital AMC, Amsterdam, The Netherlands.
authors.forename: R M E
authors.initials: RM
authors.lastname: Blümer
authors.forename: N S
authors.initials: NS
authors.lastname: Hessel
authors.forename: R
authors.initials: R
authors.lastname: van Baren
authors.forename: C F
authors.initials: CF
authors.lastname: Kuyper
authors.forename: D C
authors.initials: DC
authors.lastname: Aronson
mesh_terms: D002921:Cicatrix / Q000209:etiology; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D004939:Esophageal Perforation / Q000209:etiology; D005500:Follow-Up Studies; D017219:Gastric Outlet Obstruction / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D007223:Infant; D007431:Intraoperative Complications / Q000209:etiology; D007902:Length of Stay; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D012189:Retrospective Studies; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014463:Ultrasonography