Intraumbilical longitudinal incision safer than conventional approach while performing pyloromyotomy

A new study published in the The Tokai Journal of Experimental and Clinical Medicine found that pyloromyotomy performed through the intraumbilical longitudinal incision was as safe as supraumbilical incision and aids in improving cosmetic results.

Hypertrophic pyloric stenosis is a condition commonly found in infants, characterized by the thickening of the muscles in the pylorus, leading to feeding difficulties and vomiting. Surgical intervention, known as pyloromyotomy, is often required to treat this condition. In 2012, a new transumbilical approach utilizing an intraumbilical longitudinal incision was introduced. 

A recent study by Suzuki and team, sought to evaluate the outcomes of pyloromyotomy using the intraumbilical longitudinal incision approach compared to the conventional supraumbilical incision. They reviewed the medical records of patients who underwent transumbilical pyloromyotomy between 2005 and 2018.

The study included 24 patients in the intraumbilical group and 28 patients in the supraumbilical group. The findings revealed that the median operative time was slightly longer in the intraumbilical group, with a statistically significant difference (58.0 minutes vs. 43.5 minutes, p = 0.002). However, the time to full feeding did not significantly differ between the two groups. Notably, the median postoperative stay was shorter in the intraumbilical group (3 days vs. 5.5 days, p = 0.003).

Importantly, complications were comparable between the two groups, with no significant difference observed (4.2% vs. 7.1%, p = 1.0). The study also noted that scars resulting from the intraumbilical longitudinal incision were localized inside the umbilicus, potentially leading to improved cosmetic outcomes.

The promising results of this study suggest that pyloromyotomy through the intraumbilical longitudinal incision is a safe alternative to the conventional approach. Although the operative time was slightly longer, the benefits of reduced postoperative stay and potentially improved cosmetic results are significant considerations. This technique has the potential to enhance the overall patient experience and satisfaction.

Further research and larger-scale studies are warranted to validate these findings and explore the long-term outcomes associated with the intraumbilical approach. The adoption of this innovative technique could offer an alternative option for surgeons performing pyloromyotomy and contribute to the ongoing evolution of surgical procedures.

Source:

Suzuki, K., Komura, M., Satake, R., Terawaki, K., Kodaka, T., Gohara, T., & Yonekawa, H. (2023). The First Application of Intraumbilical Longitudinal Incision to Pyloromyotomy for Hypertrophic Pyloric Stenosis. The Tokai Journal of Experimental and Clinical Medicine, 48(2), 67-71.