Circumumbilical pyloromyotomy: larger pyloric tumours need an extended incision

Circumumbilical pyloromyotomy has been used widely to offer an optimum cosmetic approach. On occasion, there are difficulties in delivering the large pyloric tumour through a relatively small incision. The authors prospectively collected a series of 39 consecutive pyloromyotomies performed over a period of 3 years in three teaching hospitals. Patients were aged 13 to 90 days (average 35) and the male-female ratio was 5:1. The initial operative approach was a right upper quadrant (RUQ) incision (n=6) and later a circumumbilical incision (CUI), with or without lateral extension, combined with transverse division of the linea alba and part of both rectus muscles (n=33). Two infants (1 RUQ and 1 CUI) developed wound infections, which were treated with antibiotics. There were no other peri- or postoperative complications. It was necessary to extend the incision in one-third of CUI cases (n=12) in order to facilitate the delivery of a large pyloric tumour through the incision. Both omega-shaped (n=3) and a new modified extension (n=9) have been used with good cosmetic results.