Comparison between umbilical and transverse right upper abdominal incision for pyloromyotomy

Blumer, Ronald; Hessel, N.S.; Baren, Robertine van; Kuyper, C.F; Aronson, D. C.

doi:10.1016/j.jpedsurg.2004.03.063

Cited by 46 publications

(43 citation statements)

References 12 publications

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“…Patients receiving antibiotic prophylaxis in these studies have had a decreased incidence of wound infection; however, the results have lacked statistical significance. Other groups have reported no difference in wound infection rates between the standard RUQ and supraumbilical approach, whereas others have noted an increase in wound infections with the RUQ incision [14]. In our study, the risk of wound infection by classic pyloromyotomy is 2.3%, which is consistent with other studies [5,13].…”

Section: Discussionsupporting

confidence: 91%

Supraumbilical pyloromyotomy: a unique indication for antimicrobial prophylaxis

Ladd

Nemeth

Kirincich

et al. 2005

Journal of Pediatric Surgery

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Section: Discussionsupporting

confidence: 91%

Supraumbilical pyloromyotomy: a unique indication for antimicrobial prophylaxis

Ladd

Nemeth

Kirincich

et al. 2005

Journal of Pediatric Surgery

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“…Furthermore, alternative approaches more commonly performed at pediatric centres, including periumbilical and laparoscopic pyloromyotomies, can improve cosmesis without increasing complication rates. 15 As seen in other studies, our study found no differences in complication rates or LOS with a laparoscopic approach. 16 This study was not powered to look at this specifically; larger studies examining this specific variable are needed to determine any true effect of a minimally invasive approach to pyloromyotomies.…”

Section: Management Of Hps In the Maritimes Between 2001 Andsupporting

confidence: 84%

Hypertrophic pyloric stenosis in the Maritimes: examining the waves of change over time

Ednie

Amram

Creaser

et al. 2016

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Background: Changing patterns of referral and management of pediatric surgical conditions, including hypertrophic pyloric stenosis (HPS), have recently been described and often relate to comfort with early nonoperative management, anesthesia and corrective surgery. Travelling distance required for treatment at pediatric centres can also be burdensome for families. We assessed referral patterns for HPS in the maritime provinces of Canada over 10 years to quantify the burden on families travelling for surgical care. Methods:We reviewed the charts of all patients with HPS in the Maritimes. Length of hospital stay (LOS) and complication rates were analyzed in regards to resuscitation and management at a pediatric centre and/or peripheral centres. We used postal codes for each patient to track distance travelled for management. Results:We assessed 751 cases of HPS. During the study period (Jan. 1, 2001-Dec. 31, 2010), referral to pediatric centres increased from 49% to 71%. Postoperative complications were 2.5-fold higher in peripheral centres. Infants referred to pediatric centres were 78% less likely to have an LOS longer than 3 days. Laparoscopic pyloromyotomy, which was performed only in pediatric centres, was associated with a shorter postoperative LOS.

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“…The pyloromyotomy is not without complications, although they are uncommon. Most recent reports about pyloromyotomy concern the differences between the procedures through the umbilical route [2,4,11,15,19] or the laparoscopic technique [3,7,9,17,18,20]. Until now a debate has gone on as to whether this procedure can be safely performed in general hospitals with special interest in surgery in children.…”

Section: Discussionmentioning

confidence: 99%

“…There has been some concern that the umbilical approach is associated with higher infection rates. The incidence of wound infection after umbilical incision ranges from 4.2-20% [2,11]. A study showed incidences of wound infections for the right upper quadrant and umbilical incision of 6.7 and 1.2%, respectively, which dropped to 4.5 and 0% when prophylactic antibiotics were used [11].…”

Section: Discussionmentioning

confidence: 99%

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Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital?

et al. 2006

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In order to document the incidence of perioperative complications in patients with infantile hypertrophic pyloric stenosis, a descriptive cohort study was performed in two teaching hospitals in the Netherlands. One hospital specialized in pediatric surgery and the other was a general surgery teaching hospital. All consecutive infants who underwent pyloromyotomy for the diagnosis hypertrophic pyloric stenosis in both hospitals between 1998 and 2002 were included. The children were diagnosed and treated according to a standard protocol. From all charts, complications durante- and post-operationem were recorded. A total of 256 pyloromyotomies were performed. Registered perioperative complications were duodenal mucosal perforation (n=6; 2%). Perioperatively unrecognized duodenal mucosal perforation occurred four times (1%). One re-operation was performed for an incomplete pyloromyotomy (0.3%). Persistent vomiting after the operation occurred in 18 children (7%). A large majority of postoperative complications were wound infections (n=16; 6%), 12 after right upper quadrant incision and 4 after umbilical incision; most of them were treated with antibiotics and/or incision for drainage of an abscess. An incisional hernia occurred four times. Prolonged vomiting was the only postoperative complication that differed significantly between the two teaching hospitals. The overall percentages of complications were equal to complication rates in literature, and since there were no extensive differences in major complications between the two teaching hospitals in this study, we can conclude that pyloromyotomy can be performed safely in specialized centers and in general centers provided with a multidisciplinary team.

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Comparison between umbilical and transverse right upper abdominal incision for pyloromyotomy

Cited by 46 publications

References 12 publications

Supraumbilical pyloromyotomy: a unique indication for antimicrobial prophylaxis

Supraumbilical pyloromyotomy: a unique indication for antimicrobial prophylaxis

Hypertrophic pyloric stenosis in the Maritimes: examining the waves of change over time

Can pyloromyotomy for infantile hypertrophic pyloric stenosis be performed in any hospital?

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