title: Pyloromyotomy through a sliding umbilical window.
abstract: OBJECTIVE
  The semi-circumumbilical incision for treatment of infantile hypertrophic pyloric stenosis, described by Tan and Bianchi (Tan KC, Bianchi A. Circumumbilical incision for pyloromyotomy. Br J Surg 1986;73:399), does not allow a comfortable access to the pylorus in up to 30% of cases, resulting, not infrequently, in unexpected seromuscular lacerations. To get easier access to the pylorus we have performed the Ramstedt pyloromyotomy through a sliding umbilical window after full-circumumbilical incision in 13 initial consecutive cases.
  
  
  METHODS
  Skin was incised along the entire circumference of the umbilicus, and then was undermined, creating a circular subcutaneous space, 8 cm in diameter. The umbilical window, about 1.5 cm in diameter, was slid diagonally toward the right upper quadrant, by shifting a pair of muscle retractors, 3 to 4 cm from the umbilicus, with the umbilicus left in its original position under the slid skin. Through the sliding window at the right upper quadrant, the abdomen was entered, and the hypertrophied pylorus was identified within the center of the window. Then the pyloromyotomy was performed intracorporeally with ease.
  
  
  RESULTS
  In all 13 infants, an adequate pyloromyotomy was safely performed. The wound healed primarily in all cases, without leaving conspicuous scar, subcutaneous abscess formation, or incisional hernia. The postoperative course was quite uneventful in each.
  
  
  CONCLUSIONS
  This new approach allows far easier access to and exposure of the pylorus, and facilitates a safe intracorporeal pyloromyotomy, and achieves an excellent cosmetic outcome.
authors.affiliation: Department of Pediatric Surgery, The Jichi Medical University, Shimotsuke City, Tochigi 329-0498, Japan. kyokomori@jichi.ac.jp
authors.forename: Kinji
authors.initials: K
authors.lastname: Yokomori
authors.forename: Takaharu
authors.initials: T
authors.lastname: Oue
authors.forename: Takayuki
authors.initials: T
authors.lastname: Odajima
authors.forename: Naokatsu
authors.initials: N
authors.lastname: Baba
authors.forename: Daijo
authors.initials: D
authors.lastname: Hashimoto
mesh_terms: D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*; D014472:Umbilicus / Q000601:surgery*