Experience with a nonlaparoscopic, transumbilical, intracavitary pyloromyotomy.

摘要: Abstract Background/Purpose Ramstedt's pyloromyotomy for hypertrophic pyloric stenosis is elegant, effective, and time-honored. Although its basic principle has not changed over the last 95 years, considerable debate exists concerning preferred access to pylorus muscle-splitting technique. Reviewed here experience with an approach that combines ease safety of “open” advantages minimal invasiveness. Methods This series encompasses 75 consecutive, prospectively recorded pyloromyotomies. A short, curved upper umbilical rim incision made. The linea alba transected transversally abdomen entered. grasped a Babcock clamp lifted incision, but delivered. Two 3:0 guy sutures are placed in hypertrophied musculature lift maintain place. longitudinal serosal made deepened 1 3 mm. double-pronged skin hooks placed, one on each partially separated edge, gentle upward outward traction applied until complete splitting achieved. mucosa touched by instrument. Results age children ranged from 9 89 days (mean, 40; median, 36). Their weight 2.4 5.4 kg 3.7 kg; 3.6). Fifty-seven were boys. mean operating time was 28 minutes. muscle performed general surgical residents 66. There no mucosal injuries. Seventy-two discharged within 24 hours, remaining 48 hours. superficial wound infections suture reaction occurred. recurrences. Conclusion Transumbilical intracavitary safe, reproducible procedure combining two most commonly employed approaches (traditional laparoscopic). Because delivered, smaller used. scar virtually invisible. this renders it well suited teaching setting.