Operative technique
The squeeze technique to assist transumbilical delivery of pyloric tumor

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Abstract

Background/Purpose

The popularity of the transumbilical approach for the treatment of infantile hypertrophic pyloric stenosis has increased over recent years mainly because of its superior cosmetic result. However, delivering a large pyloric tumor through a small incision can be technically demanding and is associated with significant complications. Described in this article is a novel yet simple technique to facilitate delivery of the pyloric tumor.

Method

This is a prospective report of an 8-year experience of a single surgeon on consecutive patients with pyloric stenosis who underwent transumbilical pyloromyotomy assisted by the squeeze technique. Information on patient demographics, perioperative performance, and postoperative stay were recorded and analyzed. A standard surgical approach and postoperative feeding regimen were used in all cases.

Results

Forty-six patients were operated on at a mean of 5.5 weeks and discharged 2.5 days postsurgery. There were no significant intra- or postoperative complications, and all patients were reviewed at 6 weeks postdischarge.

Conclusion

The success of the squeeze technique in facilitating delivery of the pylorus strengthens the case for the continued use of the transumbilical over traditional and laparoscopic approaches for infantile hypertrophic pyloric stenosis.

Section snippets

Method

This is a prospective record of a single surgeon's experience over an 8-year period, between July 1996 and December 2004. Data were stored in EMAS, an in house, and a Microsoft Access database. Information on patient demographics, perioperative performance, and postoperative stay were recorded and analyzed. A standard surgical approach and postoperative feeding regimen were used in all cases.

Technique

A single dose of flucloxacillin or Co- amoxyclav (30 mg/kg) is administered on induction of anesthesia, and a hemicircumferential incision is sited in the superior umbilical fold. The linea alba is exposed for 3 cm cranially before being opened between stay sutures. The peritoneal cavity is entered, and the antrum of stomach is delivered to the outside. Upward traction on the antrum, held between the left thumb and the index finger, allows the pylorus to be drawn up to the anterior abdominal

Result

A total of 46 patients were operated on over the period of study. Of the 46 patients, 10 were female and 36 male, with mean age of 5.5 weeks (range, 2-10). The use of the squeeze technique resulted in the delivery of all but 7 cases that required extension of either or both skin and linea alba incisions. There were no instances of serosal tears in either the antrum or the duodenum. Mean operating time was 38.2 minutes (range, 15-78). There were no documented intra- or postoperative

Discussion

The transumbilical approach for the delivery of pyloric tumors has been widely, although not universally, applied because of real and perceived risk inherent to this approach. The delivery of particularly large pyloric tumors through a small umbilical incision can be a challenging undertaking, which has been reported to cause injury to the anterior wall and mucosa of stomach and duodenum with prolongation of the operative and recovery time [1], [2], [3], [4]. Therefore, various modifications to

References (11)

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