Estenosis hipertrófica de píloro: comparación entre la incisión transversa y la supraumbilical / Hypertrophic pyloric stenosis: comparison between transversal and supraumbilical incision

RESUMEN

Objetivo. El tratamiento de la estenosis hipertrófica de píloro es lapiloromiotomía extramucosa. El abordaje quirúrgico aún genera controversia. Nuestro objetivo es comparar los resultados de los abordajes transverso en hipocondrio derecho (THD) y supraumbilical (SUP)en nuestra experiencia. Material y métodos. Estudio descriptivo retrospectivo de 56 pacientes con EHP, 38 THD (70%), 18 SUP (30%), tratados en nuestro servicio entre 2003 y 2007. Analizamos los datos demográficos, pre, peri y postoperatorios. Agrupamos las complicaciones en mayores (perforación duodenal, piloromiotomía incompleta y evisceración) y menores(seroma, hematoma, infección de herida quirúrgica y hernia de pared).El análisis estadístico de los datos se ha realizado a través de pruebasparamétricas y no paramétricas. Resultados. En nuestros pacientes, el abordaje SUP ha asociado (..) (AU)

ABSTRACT

Background/purpose. The treatment of hypertrophic pyloric stenosis is the Fredet-Ramstedt pyloromyotomy. It is controversial what surgical approach to choose. We evaluate our outcome with the right upperquadrant (RUQ) and the supraumbilical (SU) approach. Methods. Between 2003 and 2007, we performed 38 pyloromyotomies through a RUQ incision and 18 through a SU approach. Weanalyze patient demographics and pre and postoperative data. We group the complications in major (duodenal perforation, inadequate pyloromyotomy, and wound dehiscence) and minor (seroma, hematoma, wound infection and incisional hernia). A nonrandomized comparison was performed between the two groups. Results. We find significant differences in morbidity: 22.2% of major complications ocurred in the SU group versus 2.6% in the RUQ group, and 44.4% of minor complications were encountered in the SU group versus 2.6% in the RUQ group (P < 0.005).Conclusions. In our study we found a significantly higher overall omplication rate in the SU group (p < 0.005), possibly because of a more difficult delivery of the pylorus through the SU incision and becauseof a probably increased rate of wound infection associated with thesupraumbilical approach in the pediatric population (AU)