Ramstedt's pyloromyotomy: a specialist procedure?

One hundred and twenty infants with infantile hypertrophic pyloric stenosis were operated on by two consultant general surgeons over a 13-year period. General anaesthetic and a standard surgical approach was used in all cases. No mortality was recorded and there were no wound dehiscences. The overall postoperative wound infection rate was 9.2%. Prior to 1985 the infection rate was 15%. Following attention to a number of details including care of the umbilicus, the incidence decreased after 1985 to 4%. The most common postoperative complication was vomiting, which occurred in 25% of infants. There was one negative laparotomy in the 13-year study period. Two children required a second procedure for persistent vomiting. The argument in favour of specialisation in managing this condition is questioned along with the need for intensive diagnostic investigation.