Supraumbilical pyloromyotomy: A unique indication for antimicrobial prophylaxis

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

Research output: Contribution to journalArticlepeer-review

26 Scopus citations


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 (US)
Pages (from-to)974-977
Number of pages4
JournalJournal of pediatric surgery
Issue number6
StatePublished - Jun 2005


  • Antimicrobial prophylaxis
  • Infection
  • Pyloric stenosis
  • Supraumbilical pyloromyotomy

ASJC Scopus subject areas

  • Surgery
  • Pediatrics, Perinatology, and Child Health


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