Minimally Invasive Supraumbilical Approach for Pyloromyotomy.

BACKGROUND: The three major approaches for Ramstedt pyloromyotomy - right upper quadrant incision, supraumbilical incision and laparoscopic method, are often compared, with some preference given to the supraumbilical approach. It becomes widely adopted in many centers around the world. AIM: To analyse the early results of the supraumbilical incision in treatment of hypertrophic pyloric stenosis and to test a hypothesis that this technique may be valuable in our clinical conditions. MATERIALS AND METHODS: Within a ten-month period five children with hypertrophic pyloric stenosis were selected (using single random sample) for pyloromyotomy via supraumbilical incision and another five children - via Robertson incision. This technique consists of semi lunar cutting in the upper half of umbilicus, extended cranially in the midline. After a Ramstedt pyloromyotomy, linea alba is sutured and the reshaped skin is sutured in semilunar manner around the umbilicus. The scar was estimated with Patient and Observer Scar Assessment Scale. RESULTS: The operations were performed by pediatric surgeons with different experience and with basic equipment. The operative time was 5-10 min longer for the supraumbilical incision. The pyloromyotomy led to a definitive healing, with timely feeding and discharging, without any complication. The quality of the scar was significantly better after the supraumbilical incision. CONCLUSION: Supraumbilical incision is reliable and related to low complication rates. It leaves better scar than the Robertson incision and is an excellent alternative in search for less invasive techniques.

[Recurrent hypertrophic pyloric stenosis - diagnostics and treatment].

Hypertrophic pyloric stenosis (HPS) is the most common surgically treated disease causing vomiting in infancy, and pyloromyotomy presents around 30% of all operations in this period. Recurrence of the disease is the most serious complication in its treatment. For 16 years period (2000 - 2015) 154 children with HPS were operated n Pediatric Surgery, Plovdiv. Four of them (2.6%), two boys and two girls, were reoperated due to recurrent HPS. Three of the children were sent by other hospital, one of which having Pediatric Surgery, and the other two from regional hospitals. In one case the pyloromyotomy was performed by a general surgeon. The fourth child with recurrent HPS was operated in our clinic. Reoperations were performed between 3rd and 12th day after the first operation (mean 7.5 days). In one case a Heineke mikulicz pyloroplasty was the procedure of choice, and in the other three cases a new pyloromyotomy was made in a different place. Pyloromyotomy for HPS is a routine procedure in pediatric surgery, which has its typical complications and one such is the recurrent HPS. Insufficiently performed pyloromyotomy is among the leading causes for recurrent HPS, therefore, a high level of competence in every surgeon performing it is crucial.

Acute paediatric bite injuries treated on inpatient basis: a 10-year retrospective study and criteria for hospital admission.

The aim of this study was to evaluate the acute bite wounds in children treated on an inpatient basis over a 10-year period and the criteria for inpatient treatment. This study comprised all acute mammalian bite injuries in relation to all paediatric bite injuries seen at the Emergency Surgical Department (ESD). Inclusion criteria were: aged between 0-18 years; acute human or animal bite injuries (presenting for the first time); and inpatient treatment. Exclusion criteria were: bite wounds treated elsewhere and referred for complications; bites treated on an outpatient basis referred for complications; and all insect bites. Over 10 years, 12,948 children were seen at the ESD. There were 167 children (0.77%) with mammalian bite wounds. Twelve of them responded to the inclusion criteria. They presented 7.18% of all mammalian bite injuries and 0.09% of all paediatric emergency visits at the ESD. The average age was 3.82 ± 1.63 years (from 1.3-7 years). The time elapsed between the accident to the wound debridement was 118.64 ± 101.39 minutes. There were 10 dogs, one horse, and one rabbit bite. Surgical treatment comprised debridement, saline irrigation, and primary closure or reconstruction. All patients received antibiotics in the postoperative period. The average hospital stay was 5.92 ± 2.39 days. In one case a partial distal flap necrosis occurred. Animal bite injuries treated on an inpatient basis are predominantly dog bites in young children under 10 years of age, with deep, extended, and commonly multiple injuries. Only 7% of paediatric bite injuries require inpatient treatment.