SpringerLink
Log in

Comparison between umbilical and right upper transverse abdominal incisions for pyloromyotomy: a systematic review and meta-analysis

  • Review
  • Published:
Pediatric Surgery International Aims and scope Submit manuscript

Abstract

The aim of this study was to compare the operative parameters and complication rates between the umbilical (UMB) and right upper quadrant (RUQ) skin incisions for Ramstedt’s pyloromyotomy for the treatment of infantile hypertrophic pyloric stenosis (IHPS). PubMed, EMBASE, Web of Science and Scopus databases were systematically searched. The studies where any one of the main outcomes of interest, i.e., operative time, wound infection rate, mucosal perforation rate were reported were eligible for inclusion. The statistical analysis was performed using a random-effects model. The methodological quality of the studies was assessed utilizing the Newcastle–Ottawa Scale. Fifteen studies comprising 2964 infants were included. As compared to the UMB group, the RUQ group showed a significantly lower mean operative time (p = 0.0004), wound infection rate (p < 0.0001) and mucosal perforation rate (p = 0.02). Although UMB incision produces an almost undetectable scar, this approach results in significantly more complications. Therefore, the risks and benefits must be weighed and discussed with the caregivers in deciding the surgical approach in patients with IHPS. However, due to a poor methodological quality of nine out of fifteen studies, further studies need to be conducted for an optimal comparison between the two groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
EUR 32.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or Ebook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price includes VAT (Germany)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

Similar content being viewed by others

Data availability

No datasets were generated or analysed during the current study.

References

  1. Kapoor R, Kancherla V, Cao Y et al (2019) Prevalence and descriptive epidemiology of infantile hypertrophic pyloric stenosis in the United States: a multistate, population-based retrospective study, 1999–2010. Birth Defects Res 111:159–169. https://doi.org/10.1002/bdr2.1439

    Article  CAS  PubMed  Google Scholar 

  2. Leong M-M, Chen SC-C, Hsieh C-S et al (2011) Epidemiological features of infantile hypertrophic pyloric stenosis in Taiwanese children: a nation-wide analysis of cases during 1997–2007. PLoS ONE 6:e19404. https://doi.org/10.1371/journal.pone.0019404

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Spicer RD (1982) Infantile hypertrophic pyloric stenosis: a review. Br J Surg 69:128–135. https://doi.org/10.1002/bjs.1800690304

    Article  CAS  PubMed  Google Scholar 

  4. Hussain M (2008) Sonographic diagnosis of infantile hypertrophic pyloric stenosis- use of simultaneous grey-scale & colour Doppler examination. Int J Health Sci 2:134–140

    Google Scholar 

  5. Meissner PE, Engelmann G, Troeger J et al (2006) Conservative treatment of infantile hypertrophic pyloric stenosis with intravenous atropine sulfate does not replace pyloromyotomy. Pediatr Surg Int 22:1021–1024. https://doi.org/10.1007/s00383-006-1751-3

    Article  CAS  PubMed  Google Scholar 

  6. Mazurak M, Patkowski D (2021) A history of the surgical correction of pyloric stenosis. J Pediatr Surg 56:1904–1907. https://doi.org/10.1016/j.jpedsurg.2021.05.009

    Article  PubMed  Google Scholar 

  7. Bensard DD (2009) Hypertrophic pyloric stenosis. In: Harken AH, Moore EE (eds) Abernathy’s Surgical Secrets, 6th edn. Mosby, Philadelphia, pp 415–416

    Chapter  Google Scholar 

  8. Levi B, Mychaliska GB (2010) Operative management of pyloric stenosis: pyloromyotomy. In: Minter RM, Doherty GM (eds) Current Procedures: Surgery, 1st edn. The McGraw-Hill Companies, New York, NY, pp 366–370

    Google Scholar 

  9. Tan KC, Bianchi A (1986) Circumumbilical incision for pyloromyotomy. Br J Surg 73:399. https://doi.org/10.1002/bjs.1800730529

    Article  CAS  PubMed  Google Scholar 

  10. Hernández-Vaquero ID, Palacios MEC, Rodríguez RF et al (2023) Analysis of esthetic assessment scales in two surgical approaches for hypertrophic pyloric stenosis. Cirugia Pediatr Organo Of Soc Espanola Cirugia Pediatr 36:12–16

    Google Scholar 

  11. Wells G, Shea B, O’Connell D, et al (2000) The Newcastle–Ottawa scale (NOS) for assessing the quality of non-randomized studies in meta-analysis. Ottawa Hospital Research Institute. https://www.ohri.ca/programs/clinical_epidemiology/oxford.asp. Accessed 17 Feb 2024

  12. Peyvasteh M, Askarpour S, Khoshkhabar M, Javaherizadeh H (2020) Pyloromyotomy in hypertrophic pyloric stenosis: a comparative study between supraumbilical curved skin incision and standard (right upper quadrant) skin incision: study in a resource limited setting. Open Access Surg 13:79–83. https://doi.org/10.2147/OAS.S262825

    Article  Google Scholar 

  13. Habib M, Raza R, Ahmed M et al (2023) A comparative study of Bianchi versus right upper transverse approach in infantile hypertrophic pyloric stenosis. J Surg Protoc Res Methodol. https://doi.org/10.1093/jsprm/snac025

    Article  Google Scholar 

  14. Meyer T, Jud S, Höcht B (2007) Therapy of infantile hypetrophic pylorus stenosis. Comparison of two different surgical skin incisions for pyloromyotomy by Weber-Ramstedt. Padiatrische Prax 70:453–459

    Google Scholar 

  15. Kuroiwa M, Suzuki N, Takahashi A et al (2001) Circumumbilical incision for pyloromyotomy in hypertrophic pyloric stenosis. Kitakanto Med J 51:295–299. https://doi.org/10.2974/kmj.51.295

    Article  Google Scholar 

  16. Carrera N, Cerdá JA, Cañizo A et al (2010) Hypertrophic pyloric stenosis: comparison between transversal and supraumbilical incision. Cirugia Pediatr Organo Of Soc Espanola Cirugia Pediatr 23:77–81

    CAS  Google Scholar 

  17. Fitzgerald PG, Lau GY, Langer JC, Cameron GS (1990) Umbilical fold incision for pyloromyotomy. J Pediatr Surg 25:1117–1118. https://doi.org/10.1016/0022-3468(90)90743-s

    Article  CAS  PubMed  Google Scholar 

  18. Huddart SN, Bianchi A, Kumar V, Gough DCS (1993) Ramstedt’s pyloromyotomy: circumumbilical versus transverse approach. Pediatr Surg Int 8:395–396. https://doi.org/10.1007/BF00176726

    Article  Google Scholar 

  19. Poli-Merol ML, Francois S, Lefebvre F et al (1996) Interest of umbilical fold incision for pyloromyotomy. Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Kinderchir 6:13–14. https://doi.org/10.1055/s-2008-1066458

    Article  CAS  Google Scholar 

  20. Podevin G, Missirlu A, Branchereau S et al (1997) Umbilical incision for pyloromyotomy. Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Kinderchir 7:8–10. https://doi.org/10.1055/s-2008-1071039

    Article  CAS  Google Scholar 

  21. Leinwand MJ, Shaul DB, Anderson KD (1999) The umbilical fold approach to pyloromyotomy: is it a safe alternative to the right upper-quadrant approach? J Am Coll Surg 189:362–367. https://doi.org/10.1016/S1072-7515(99)00136-2

    Article  CAS  PubMed  Google Scholar 

  22. Blümer RME, Hessel NS, van Baren R et al (2004) Comparison between umbilical and transverse right upper abdominal incision for pyloromyotomy. J Pediatr Surg 39:1091–1093. https://doi.org/10.1016/j.jpedsurg.2004.03.063

    Article  PubMed  Google Scholar 

  23. Kim SS, Lau ST, Lee SL et al (2005) Pyloromyotomy: a comparison of laparoscopic, circumumbilical, and right upper quadrant operative techniques. J Am Coll Surg 201:66–70. https://doi.org/10.1016/j.jamcollsurg.2005.03.020

    Article  PubMed  Google Scholar 

  24. Aldridge RD, MacKinlay GA, Aldridge RB (2007) Choice of incision: the experience and evolution of surgical management of infantile hypertrophic pyloric stenosis. J Laparoendosc Adv Surg Tech A 17:131–136. https://doi.org/10.1089/lap.2006.0525

    Article  PubMed  Google Scholar 

  25. Taqi E, Boutros J, Emil S et al (2007) Evaluation of surgical approaches to pyloromyotomy: a single-center experience. J Pediatr Surg 42:865–868. https://doi.org/10.1016/j.jpedsurg.2006.12.051

    Article  PubMed  Google Scholar 

  26. Perger L, Fuchs JR, Komidar L, Mooney DP (2009) Impact of surgical approach on outcome in 622 consecutive pyloromyotomies at a pediatric teaching institution. J Pediatr Surg 44:2119–2125. https://doi.org/10.1016/j.jpedsurg.2009.02.067

    Article  PubMed  Google Scholar 

  27. Tander B, Shanti CM, Klein MD (2009) Access to the hypertrophic pylorus: does it make a difference to the patient? Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Kinderchir 19:14–16. https://doi.org/10.1055/s-2008-1039006

    Article  CAS  Google Scholar 

  28. Zakaria OM (2016) Non-laparoscopic minimal surgical approach to pyloromyotomy: an experience from a challenged resource setting. Afr J Paediatr Surg AJPS 13:189–192. https://doi.org/10.4103/0189-6725.194672

    Article  PubMed  Google Scholar 

  29. Hulka F, Harrison MW, Campbell TJ, Campbell JR (1997) Complications of pyloromyotomy for infantile hypertrophic pyloric stenosis. Am J Surg 173:450–452. https://doi.org/10.1016/S0002-9610(97)00075-5

    Article  CAS  PubMed  Google Scholar 

  30. Aiolfi A, Asti E, Costa E et al (2018) Umbilical microbiome and laparoscopic surgery: a descriptive clinical study. J Laparoendosc Adv Surg Tech A 28:1196–1201. https://doi.org/10.1089/lap.2018.0140

    Article  PubMed  Google Scholar 

  31. Besson R, Sfeir R, Salakos C, Debeugny P (1997) Congenital pyloric stenosis: a modified umbilical incision for pyloromyotomy. Pediatr Surg Int 12:224–225

    Article  PubMed  Google Scholar 

  32. Hope WW, Tuma F (2024) Incisional Hernia. In: StatPearls. https://www.ncbi.nlm.nih.gov/books/NBK435995/. Accessed 23 Feb 2024

Download references

Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. All India Institute of Medical Sciences, New Delhi, India

    Hemant Khandelia

  2. Department of Pediatric Surgery, All India Institute of Medical Sciences, Ansari Nagar East, New Delhi, 110029, India

    Nellai Krishnan, Ajay Verma, Sachit Anand & Sandeep Agarwala

  3. Division of Neonatology, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India

    Deepika Kainth

Authors
  1. Hemant Khandelia
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nellai Krishnan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Deepika Kainth
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ajay Verma
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Sachit Anand
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Sandeep Agarwala
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

H.K.: systematic literature search, Data Extraction, Formal Analysis, Writing—original draft; N.K.: data Extraction, Formal analysis, Writing—original draft; D.K.: methodological quality assessment, Writing—review and editing, Supervision; A.V.: methodological quality assessment, Writing—review and editing; S.An.: conceptualization, Systematic search, Formal analysis; S.Ag.: supervision, Validation, Writing—review and editing.

Corresponding author

Correspondence to Sachit Anand.

Ethics declarations

Conflict of interest

The authors report no competing interests in this article.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 14 KB)

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Khandelia, H., Krishnan, N., Kainth, D. et al. Comparison between umbilical and right upper transverse abdominal incisions for pyloromyotomy: a systematic review and meta-analysis. Pediatr Surg Int 40, 163 (2024). https://doi.org/10.1007/s00383-024-05747-4

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s00383-024-05747-4

Keywords

Search

Navigation