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The aim of this study was to compare the operative parameters and complication rates between the umbilical (UMB) and right upper quadrant (RUQ) skin incisions for Ramstedt's pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis (IHPS). PubMed, EMBASE, Web of Science and Scopus databases were systematically searched. The studies where any one of the main outcomes of interest, i.e., operative time, wound infection rate, mucosal perforation rate were reported were eligible for inclusion. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle-Ottawa Scale. Fifteen studies comprising 2964 infants were included. As compared to the UMB group, the RUQ group showed a significantly lower mean operative time (p = 0.0004), wound infection rate (p < 0.0001) and mucosal perforation rate (p = 0.02). Although UMB incision produces an almost undetectable scar, this approach results in significantly more complications. Therefore, the risks and benefits must be weighed and discussed with the caregivers in deciding the surgical approach in patients with IHPS. However, due to a poor methodological quality of nine out of fifteen studies, further studies need to be conducted for an optimal comparison between the two groups., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Laparoscopic pyloromyotomy has become a gold standard for the treatment of congenital hypertrophic pyloric stenosis (HPS). There have been recent reports on the use of transumbilical single-site laparoscopic surgery for congenital HPS; however, using transumbilical single-site laparoscopic surgery in pediatric cases is still controversial due to the difficulty with manipulation. In this study, some preliminary experience with the application of a novel transumbilical single-site laparoscopic approach in congenital HPS is described. Methods: A retrospective study was conducted involving 25 patients with congenital HPS treated in our hospital from August 2016 to August 2019. A pyloric electrocoagulation chisel combined with a left-handed main operation was completed in all of the patients and the operative times, postoperative length of stay, and operative complications were recorded. Results: The laparoscopic operation was completed in 25 patients with an average operative time of 21.9 ± 5.5 minutes, average postoperative length of stay of 2.5 ± 0.9 days, and no perforations of the pyloric mucosa, recurrent obstruction, surgical incision infections, and incision hernias. All of the patients had at least 3 months of follow-up, good growth and development, and the parents were satisfied with the postoperative scars. Conclusion: A pyloric electrocoagulation chisel combined with a left-handed main operation in the treatment of congenital HPS by a single-site umbilical laparoscopic pyloromyotomy is safe and effective, and can achieve a satisfactory cosmetic effect.

Purpose: Single-site umbilical laparoscopic pyloromyotomy for hypertrophic pyloric stenosis in neonates <3-week old has rarely been reported in the literature. This article reports our initial experience with this procedure., Methods: Overall, 13 cases of hypertrophic pyloric stenosis occurred in neonates <3-week old from January 2010 to April 2013 in our hospital. All neonates were treated by a single-site laparoscopic procedure. A 5-mm trocar and endoscope were introduced through an incision in the center of the umbilicus, and two 3-mm working instruments were inserted directly into the abdomen via separate lateral fascial stab incisions in the umbilical fold, and a single-site umbilical laparoscopic pyloromyotomy was then performed., Results: The procedure was performed in 13 infants (12 male) with mean age of 17.3 days. The average length of the operation was 26 min. The mean postoperative hospital stay was 4.5 days. All patients were discharged home on full feeds. Follow-up examinations were scheduled 2 to 6 weeks after discharge, and no postoperative complications were noted in any of the patients., Conclusion: These cases had shorter and thinner pylori than their older counterparts. However, the laparoscopic procedure was safe and feasible, with good postoperative results and excellent cosmesis. Surgeons should have a firm foundation of advanced minimal access surgical skills prior to attempting the procedure.

Laparoscopic pyloromyotomy was first reported 20 years ago. This technique uses a small umbilical incision and 2 small upper abdominal incisions. During the last 5 years, this approach has become the preferred technique for many pediatric surgeons in the infant who needs a pyloromyotomy. Recently, with the advent of single-site umbilical laparoscopic surgery, this approach is being used for several common pediatric conditions, including pyloric stenosis. This article will describe the single-site approach used at the Children's Hospital of Alabama and the early outcomes from its use in a relatively small group of infants. An improvement in the cosmetic appearance of the abdominal wall with the single-site approach appears to be the primary reason for its use., (Copyright © 2011. Published by Elsevier Inc.)

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., (Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Background: The optimal incision for pyloromyotomy remains controversial., Methods: A new pyloromyotomy incision has been developed. The incision is placed circumferentially in the infra-umbilical crease, and accesses the pylorus after dividing the umbilical stalk and enlarging the natural umbilical defect. After the pyloromyotomy, the fascia is closed, simultaneously repairing any concomitant umbilical hernia. Patients were followed up at 2 weeks and at three months after operation. The results of the first 14 consecutive operations over a 5-month period by, or under the supervision of, one staff surgeon are reported., Results: All 14 pyloromyotomy were successfully completed through the infra-umbilical incision. The series included 4 patients with metabolic alkalosis requiring preoperative correction. One duodenal perforation was recognized and repaired. Mean age and weight of the patients was 31.2 days (range 13-55), and 3 754 g (range 2,880-5,400), respectively. Mean operation time was 28.4 minutes (range 17-46). Mean duration between operation and discharge was 1.93 days (range 1-6), and mean total hospital stay was 2.8 days (range 1-8). There were no immediate or delayed wound complications. A virtually scarless appearance was seen in all patients on follow-up., Conclusions: A new infra-umbilical pyloromyotomy combines the benefits of the laparoscopic and open approaches and results in superb cosmesis.

Background: The aim of the study was to evaluate the effects of different access methods for the treatment of pyloric stenosis (PS)., Methods: Since 2001, we have operated on children with PS using three different access methods: classic right upper quadrant transverse incision (TI), incision on the superior umbilical fold (UI) and laparoscopic (L). We reviewed the records of these children with special emphasis on the number and characteristics of complications, operative time, and length of stay (LOS)., Results: We identified 256 patients (212 M, 44 F) with a mean age of 36 days. 138 procedures were performed using TI, 18 with UI and 100 laparoscopically. The mean operative time for patients with TI was 35.9 +/- 8.6 min, and for those with UI 31.8 +/- 9.3 min. Patients in the L group had a mean operative time of 29.8 +/- 11 min. Although the operative time for TI was significantly greater than that of L, the differences between the TI and UI groups and between UI and L groups did not reach statistical significance. For the TI, UI and L groups, the mean overall LOS was 3.22 +/- 0.3 days, 3.39 +/- 0.4 days and 2.94 +/- 0.2 days, and the mean postoperative LOS was 1.52 +/- 0.1 days, 1.44 +/- 0.2 days, and 1.56 +/- 0.1 days, respectively. No significant difference in LOS was found. One patient from each group had a wound infection. While three of four perforations occurred in the L group and the fourth was in the TI group, the difference in rates of perforation among the groups did not achieve statistical significance. The perforation during open surgery was typical, occurring on the duodenal end during spreading of the pyloric muscle. The perforations in the L group were atypical: one was a grasper injury to the duodenum; another was on the gastric end of the pyloric incision and the third occurred not during spreading of the pyloric muscle but during the cutting of it. The pylorus was relatively small in this particular case (12 mm in length)., Conclusion: While the operative time of laparoscopic repair for PS is less than in either of the open approaches, laparoscopic surgery may increase the risk for atypical injuries to the bowel. Therefore, proper attention should be paid to dissection of the structures and the selection of laparoscopic instruments. Incision on the superior umbilical fold is a reasonable alternative access for the treatment of PS.

Background/purpose: Cosmesis is considered one of the key reasons to perform pyloromyotomies through the umbilicus. We describe the results of pyloromyotomy using a supraumbilical incision with umbilicoplasty that allows ease of mobilization of the pylorus and excellent cosmetic results., Methods: The charts of all patients undergoing transumbilical pyloromyotomy with umbilicoplasty from 2002 to 2006 were retrospectively reviewed. Demographic data as well as operative time, details of surgical technique, and outcome were collected and analyzed., Results: Thirty-eight patients underwent a transumbilical pyloromyotomy with umbilicoplasty. The average operative time was 39.2 minutes (range, 11-66 minutes). The time to tolerating feeds was 1.14 days (range, 1-3 days), and the average length of stay was 1.84 days (range, 1-8 days). There were 2 complications: periumbilical cellulitis (n = 1) and incisional hernia (n = 1). There were no perforations and no incomplete pyloromyotomies. The cosmetic results on postoperative follow-up were subjectively excellent., Conclusions: Transumbilical pyloromyotomy with umbilicoplasty combines ease of exposure with ease of mobilization of the pylorus. There is minimal morbidity and an excellent cosmetic result. Time to average feeding, length of stay, and complications are similar to published reports of both open and laparoscopic pyloromyotomy.

Purpose: 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., Patients and 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., Conclusion: 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.

Background: Ramstedt pyloromyotomy through a right upper quadrant (RUQ) transverse incision has been the traditional treatment for hypertrophic pyloric stenosis. Recently, laparoscopic (LAP) and circumumbilical (UMB) approaches have been introduced as alternative methods to improve cosmesis, but concerns about greater operative times, costs, and complications remain. This study compares the three operative techniques and examines their advantages and complication rates., Study Design: We performed a retrospective review of patients undergoing pyloromyotomy at a children's hospital between January 1997 and June 2003., Results: Two hundred ninety patients underwent pyloromyotomy by LAP (n = 51), RUQ (n = 190), or UMB (n = 49). Complication rate, time to ad libitum feeding, incidence of emesis, and postoperative length of stay did not differ considerably among groups. Two LAP patients were converted to RUQ. Mucosal perforation occurred in three patients each in the RUQ and UMB groups, but none in the LAP group. Operative times were considerably less for LAP (25 +/- 9 minutes) than for RUQ (32 +/- 9 minutes) and UMB (42 +/- 12 minutes) (p < 0.05, ANOVA, Bonferroni). Charges related to operations and anesthesia were considerably greater for UMB (operation: US 1,574 dollars +/- US 433 dollars; anesthesia: US 731 dollars +/- US 190 dollars) compared with the other two groups (p < 0.05, ANOVA, Bonferroni), but did not differ between LAP (operation: US 1,299 dollars +/- US 311 dollars; anesthesia: US 586 dollars +/- US 137 dollars) and RUQ (operation: US 1,237 dollars +/- US 411 dollars; anesthesia: US 578 dollars +/- US 167 dollars). Data are presented as mean +/- SD., Conclusions: Advantages of LAP include a shorter mean operative time without higher complications or costs. UMB is associated with the greatest mean operative time and costs. Laparoscopic pyloromyotomy is a safe and effective approach to the treatment of hypertrophic pyloric stenosis.