Supraumbilical pyloromyotomy

A unique indication for antimicrobial prophylaxis

Alan P. Ladd, Shari A. Nemeth, Anna N. Kirincich, L. R. Scherer, Scott A. Engum, Frederick Rescorla, Karen W. West, Thomas M. Rouse, Deborah F. Billmire, Jay L. Grosfeld

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

Background: The umbilical fold incision for infantile hypertrophic pyloric stenosis provides a convenient exposure and cosmetically appealing scar. This study investigates the possible difference in infection rates between traditional and supraumbilical approaches for pyloromyotomy. Methods: All patients who underwent pyloromyotomy for infantile hypertrophic pyloric stenosis at a tertiary pediatric hospital were reviewed. Baseline wound infection rate was determined through review of patients with right upper quadrant incisions (group 1). A nonrandomized comparison was performed between patients with a supraumbilical approach (group 2) and those undergoing supraumbilical incisions after prophylactic antibiotic administration (group 3). Results: Complete records were reviewed on 384 patients over a 6-year period. Demographics and preoperative factors were similar among groups. The rate of infection in group 1 (n = 258) was 2.3%. With introduction of the supraumbilical approach, there was a statistically significant increase in wound infection rate to 7.0% (χ2; group 1 vs group 2, P <. 05). The use of prophylactic antibiotics with a supraumbilical approach reduced this rate of infection back to 2.3% (χ2; group 1 vs group 3, P < 1.0 and group 2 [n = 85] vs group 3 [n = 42], P <. 3). Conclusions: The risk of wound infection by classic pyloromyotomy of 2.3% is significantly increased with an open supraumbilical approach. The use of prophylactic antibiotics reduces this risk of wound infection.

Original languageEnglish
Pages (from-to)974-977
Number of pages4
JournalJournal of Pediatric Surgery
Volume40
Issue number6
DOIs
StatePublished - Jun 2005

Fingerprint

Wound Infection
Anti-Bacterial Agents
Infection
Umbilicus
Pediatric Hospitals
Patient Rights
Tertiary Care Centers
Cicatrix
Demography
Infantile Hypertrophic 1 Pyloric Stenosis

Keywords

  • Antimicrobial prophylaxis
  • Infection
  • Pyloric stenosis
  • Supraumbilical pyloromyotomy

ASJC Scopus subject areas

  • Surgery

Cite this

Ladd, A. P., Nemeth, S. A., Kirincich, A. N., Scherer, L. R., Engum, S. A., Rescorla, F., ... Grosfeld, J. L. (2005). Supraumbilical pyloromyotomy: A unique indication for antimicrobial prophylaxis. Journal of Pediatric Surgery, 40(6), 974-977. https://doi.org/10.1016/j.jpedsurg.2005.03.012

Supraumbilical pyloromyotomy : A unique indication for antimicrobial prophylaxis. / Ladd, Alan P.; Nemeth, Shari A.; Kirincich, Anna N.; Scherer, L. R.; Engum, Scott A.; Rescorla, Frederick; West, Karen W.; Rouse, Thomas M.; Billmire, Deborah F.; Grosfeld, Jay L.

In: Journal of Pediatric Surgery, Vol. 40, No. 6, 06.2005, p. 974-977.

Research output: Contribution to journalArticle

Ladd, AP, Nemeth, SA, Kirincich, AN, Scherer, LR, Engum, SA, Rescorla, F, West, KW, Rouse, TM, Billmire, DF & Grosfeld, JL 2005, 'Supraumbilical pyloromyotomy: A unique indication for antimicrobial prophylaxis', Journal of Pediatric Surgery, vol. 40, no. 6, pp. 974-977. https://doi.org/10.1016/j.jpedsurg.2005.03.012
Ladd, Alan P. ; Nemeth, Shari A. ; Kirincich, Anna N. ; Scherer, L. R. ; Engum, Scott A. ; Rescorla, Frederick ; West, Karen W. ; Rouse, Thomas M. ; Billmire, Deborah F. ; Grosfeld, Jay L. / Supraumbilical pyloromyotomy : A unique indication for antimicrobial prophylaxis. In: Journal of Pediatric Surgery. 2005 ; Vol. 40, No. 6. pp. 974-977.
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abstract = "Background: The umbilical fold incision for infantile hypertrophic pyloric stenosis provides a convenient exposure and cosmetically appealing scar. This study investigates the possible difference in infection rates between traditional and supraumbilical approaches for pyloromyotomy. Methods: All patients who underwent pyloromyotomy for infantile hypertrophic pyloric stenosis at a tertiary pediatric hospital were reviewed. Baseline wound infection rate was determined through review of patients with right upper quadrant incisions (group 1). A nonrandomized comparison was performed between patients with a supraumbilical approach (group 2) and those undergoing supraumbilical incisions after prophylactic antibiotic administration (group 3). Results: Complete records were reviewed on 384 patients over a 6-year period. Demographics and preoperative factors were similar among groups. The rate of infection in group 1 (n = 258) was 2.3{\%}. With introduction of the supraumbilical approach, there was a statistically significant increase in wound infection rate to 7.0{\%} (χ2; group 1 vs group 2, P <. 05). The use of prophylactic antibiotics with a supraumbilical approach reduced this rate of infection back to 2.3{\%} (χ2; group 1 vs group 3, P < 1.0 and group 2 [n = 85] vs group 3 [n = 42], P <. 3). Conclusions: The risk of wound infection by classic pyloromyotomy of 2.3{\%} is significantly increased with an open supraumbilical approach. The use of prophylactic antibiotics reduces this risk of wound infection.",
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AU - Engum, Scott A.

AU - Rescorla, Frederick

AU - West, Karen W.

AU - Rouse, Thomas M.

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AU - Grosfeld, Jay L.

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