Comparison between umbilical and right upper transverse abdominal incisions for pyloromyotomy: a systematic review and meta-analysis
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In brief
In brief
This meta-analysis of 2,964 infants compares umbilical versus right upper quadrant incisions for pyloromyotomy in infantile hypertrophic pyloric stenosis. RUQ incision showed significantly shorter operative time and lower rates of wound infection and mucosal perforation, though umbilical incision offers superior cosmesis.
- RUQ incision for pyloromyotomy has shorter operative time than umbilical approach (statistically significant difference, p=0.0004).
- Umbilical incision carries higher risk of wound infection and mucosal perforation compared to RUQ incision in IHPS surgery.
- Umbilical approach offers superior cosmetic outcome with nearly invisible scar, but increased complication rates must be discussed with families.
- Meta-analysis of 2964 infants shows RUQ incision may be safer despite cosmetic advantage of umbilical approach for pyloric stenosis.
- Poor methodological quality in 60% of included studies limits strength of evidence; higher-quality comparative trials needed.
Written by the GCMD Library team from the article.
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.