Supraumbilical pyloromyotomy: a comparative study between intracavitary and extracavitary techniques.

BACKGROUND: Infantile hypertrophic pyloric stenosis (IHPS) is the most common cause of nonbilious vomiting in infancy, with an incidence of 1 to 3 per 1000 live births. Different approaches have been advocated for pyloromyotomy aiming to achieve better cosmetic results with least possible complications. Although many studies have shown that the umbilical pyloromyotomy is as safe as the traditional right upper quadrant approach with superior cosmetic results, still few studies reports high complication rates. The aim of this study was to assess intracavitary pyloromyotomy (ICP) in comparison with extracavitary pyloromyotomy (ECP) regarding the operative time, operative and postoperative complications, time to return to full oral feeding, and duration of hospital stay, as well as the final cosmetic results through supra umbilical skin incision.

PATIENTS AND METHODS: Forty patients with IHPS were admitted to Assiut University Children Hospital from January 2008 to June 2010 and operated through supra umbilical incision. They were randomly divided according to the surgical technique into 2 groups: ECP group (20 patients) and ICP group (20 patients). The evaluating parameters were: pyloric muscle thickness, operative time, operative and postoperative complications, time to return to full oral feeding, duration of hospital stay, and final cosmetic results.

RESULTS: There was no statistical significant difference between both groups regarding the patient's age, weight, pyloric muscle thickness, and duration of hospital stay. No mortality was encountered among all patients. There was a statistical significant difference between both groups regarding the mean operative time and time to return to full oral feeding. During the follow-up period (ranged from 6 weeks to 8 weeks) all patients were gaining weight satisfactorily and the scar was barely visible.

CONCLUSIONS: ICP for pyloromyotomy is safe and can be done in large pyloric masses without wound extension. It gives best cosmetic results with minimal complications.