Evaluation of surgical approaches to pyloromyotomy: a single-center experience.

BACKGROUND

This study was conducted to evaluate the outcome of various approaches to pyloromyotomy: supraumbilical (SU), right upper quadrant (RUQ), and laparoscopic (LP).

METHODS

Single-center retrospective review from 1998 to 2005 with institutional review board approval, evaluating 192 pyloromyotomies based on surgical approach: RUQ (119), SU (64), and LP (9). Patient demographics, acid-base/electrolyte status on presentation, mean operative time, postoperative length of stay, and complications were evaluated.

RESULTS

Patient demographics, acid-base/electrolyte status, and mean operative time were not significantly different. The median length of stay was 34, 29, and 24.5 hours for SU, RUQ, and LP, respectively (P = .479). The frequency of duodenal/gastric perforations in the SU, RUQ, and LP groups were 1, 4, and 1, respectively. The LP perforation was not recognized intraoperatively, resulting in sepsis and multiorgan failure. One patient in the SU group had a late adhesive bowel obstruction requiring laparotomy and bowel resection. Wound infection rates did not differ significantly between groups (SU, 4; RUQ, 2; LP, 1; P = .113).

CONCLUSION

Pyloromyotomy is associated with a low complication rate. Cosmetically, SU is superior to the RUQ approach. The added benefits of being able to examine the integrity of the duodenal mucosa intraoperatively and its short learning curve may make SU a safer alternative to LP for surgeons who are still practicing the RUQ approach.