Supraumbilical pyloromyotomy: a unique indication for antimicrobial prophylaxis.
BACKGROUND
The umbilical fold incision for infantile hypertrophic pyloric stenosis provides a convenient exposure and cosmetically appealing scar. This study investigates the possible difference in infection rates between traditional and supraumbilical approaches for pyloromyotomy.


METHODS
All patients who underwent pyloromyotomy for infantile hypertrophic pyloric stenosis at a tertiary pediatric hospital were reviewed. Baseline wound infection rate was determined through review of patients with right upper quadrant incisions (group 1). A nonrandomized comparison was performed between patients with a supraumbilical approach (group 2) and those undergoing supraumbilical incisions after prophylactic antibiotic administration (group 3).


RESULTS
Complete records were reviewed on 384 patients over a 6-year period. Demographics and preoperative factors were similar among groups. The rate of infection in group 1 (n = 258) was 2.3%. With introduction of the supraumbilical approach, there was a statistically significant increase in wound infection rate to 7.0% (chi 2 ; group 1 vs group 2, P < .05). The use of prophylactic antibiotics with a supraumbilical approach reduced this rate of infection back to 2.3% (chi 2 ; group 1 vs group 3, P < 1.0 and group 2 [n = 85] vs group 3 [n = 42], P < .3).


CONCLUSIONS
The risk of wound infection by classic pyloromyotomy of 2.3% is significantly increased with an open supraumbilical approach. The use of prophylactic antibiotics reduces this risk of wound infection.
Ladd
Alan P
AP
Division of Pediatric Surgery, Riley Hospital for Children, Indianapolis, IN 46202, USA. aladd@iupui.edu
Nemeth
Shari A
SA
Kirincich
Anna N
AN
Scherer
L R
LR
Engum
Scott A
SA
Rescorla
Frederick J
FJ
West
Karen W
KW
Rouse
Thomas M
TM
Billmire
Deborah F
DF
Grosfeld
Jay L
JL
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D019072:Antibiotic Prophylaxis; D013505:Digestive System Surgical Procedures / Q000379:methods; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007902:Length of Stay; D008297:Male; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D012189:Retrospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control*
D000890:Anti-Infective Agents