Pyloromyotomy for infantile hypertrophic pyloric stenosis using a modification of the Tan and Bianchi circumumbilical approach

Abstract

Background/purpose Different approaches have been advocated for pyloromyotomy.  Since the introduction of umbilical pyloromyotomy, a number of studies have shown that it is as safe as the traditional right upper quadrant approach with superior  cosmetic results. The aim of this study was to assess the feasibility and the safety  of pyloromyotomy for infantile hyprtrophic pyloric stenosis using a modification of the Tan–Bianchi approach.

Patients and methods Over a period of 2 years, 20 infants with infantile  hypertrophic pyloric stenosis have been clinically evaluated. The umbilical approach was modified so that a transverse muscle cutting incision rather than a longitudinal midline linea alba incision was performed.

Results The total number of cases included in this study was 20 [16 male (80%)  and four female (20%) patients]. Their ages ranged from 23 to 60 days (average  42.6 ±13.54 days), and their weights ranged from 2700 to 4000 g (mean 3605± 437.4 g). Pyloromyotomy was performed safely with negligible blood loss. Four cases of serosal tear occurred, with an incidence of 20%. None of our cases showed significant complications. The mean operating time was 52.5 ± 5.073 min. The postoperative hospital stay ranged from 24 to 72 h. The postoperative course was uneventful in all patients, and, on follow-up, the circumumbilical incision left an almost undetectable scar.

Conclusion Pyloromyotomy for infantile hypertrophic pyloric stenosis using the modified Tan and Bianchi technique is feasible and safe, having an accepted operative time, early initiation of postoperative feeding, and short hospital stay. This modification combines the advantage of circumumbilical incision with its better cosmetic results and right transverse upper abdominal approach with its easy and feasible access to the pyloric mass.

Keywords: operative intervention, pyloric stenosis, Tan–Bianchi approach