Pyloromyotomy: why make an easy operation difficult?

Recently Ohri et al. advocated a modification to the standard pyloromyotomy for pyloric stenosis which they believed reduced postoperative vomiting. Their study had no control group to support their contention. We therefore compared 37 infants with hypertrophic pyloric stenosis who underwent a conventional longitudinal pyloromyotomy with the 37 infants reported by Ohri et al. who underwent a modified Ramstedt's pyloromyotomy. Data were recorded prospectively and the postoperative vomiting was assessed using the same scale as in the previous report. The incidence of vomiting was significantly less in the children undergoing the conventional operation (P = 0.03), suggesting that there is no justification for performing a double V-shaped pyloric incision in pyloric stenosis.