Operative techniqueThe squeeze technique to assist transumbilical delivery of pyloric tumor
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)
- et al.
A new technical variant for extramucosal pyloromyotomy: the Tan-Bianchi operation moves to the right
J Pediatr Surg
(2004) - et al.
Intraabdominal pyloromyotomy through the umbilical route: a technical improvement
J Pediatr Surg
(1998) - et al.
Comparison between umbilical and transverse right upper abdominal incision for pyloromyotomy
J Pediatr Surg
(2004) - et al.
Correspondence to the editor
J Pediatr Surg
(1999) - et al.
Circumbilical pyloromyotomy: larger pyloric tumours need an extended incision
Pediatr Surg Int
(2000)
Cited by (6)
Experience with a nonlaparoscopic, transumbilical, intracavitary pyloromyotomy
2008, Journal of Pediatric SurgeryCitation Excerpt :Change in this approach to the pylorus was introduced 2 decades ago by 3 trend-setting publications describing a circumumbilical incision for pyloromyotomy [19], an intraabdominal pyloromyotomy [20], and an extramucosal pyloromyotomy by laparoscopy [21]. Since these innovations, numerous variations and combination techniques have been published [22-27]. Although their main goals of minimal invasiveness with decreased pain, improved cosmesis, and maximal safety are similar, the techniques differ significantly.
Paediatric laparoscopy: New developments procedures and risks
2012, Laparoscopy: New Developments, Procedures and RisksA semicircular incision in the superior umbilical fold for SILS preserves the umbilical profile
2012, Minimally Invasive SurgeryDouble-Y pyloromyotomy: A new technique for the surgical management of infantile hypertrophic pyloric stenosis
2009, European Journal of Pediatric Surgery