A comparative study of Bianchi versus right upper transverse approach in infantile hypertrophic pyloric stenosis

Abstract

The objective of this study is to compare Bianchi supra umbilical curvilinear incision with a right upper transverse incision in patients presenting with infantile hypertrophic pyloric stenosis (IHPS) in terms of level of difficulty faced during the procedure, operative time, postoperative cosmesis, wound infection and wound dehiscence. A prospective comparative study was conducted at the Department of Paediatric Surgery, The Children’s Hospital, Pakistan Institute of Medical Sciences, Islamabad. The total duration of the study was 1 year from 1st March, 2020 to 28th February, 2021. The anticipated sample was minimum of 20 cases in Group A (Bianchi) and 20 cases in Group B (right upper quadrant incision), i.e. total 40 cases of IHPS. All infants up to 12 weeks admitted with the diagnosis of IHPS were added in the study. The study outcome was determined in terms of duration of surgery, wound infection and cosmetic effect after intervention with Bianchi and right upper transverse incision. Age and gender distribution was found equal when compared between study groups with male preponderance. The mean duration of surgery was 47.0 min in Group A, as compared with 32.5 min in Group B. Similarly, hospital stay was found slightly longer in Group A than Group B (5.3 versus 4.8 days, respectively). The level of difficulty while performing the surgery was slightly greater in Group A. The scar was detectable in all 20 (100.0%) patients in Group B compared with only 2 (10.0%) in Group A. Wound dehiscence was found in one (5.0%) patient in Group A, whereas none (0.0%) in Group B had it. The management of IHPS can be safely and successfully done with both Bianchi technique and right upper quadrant incision. The duration of surgery, level of difficulty while performing surgery and postoperative complications like wound infections and dehiscence were slightly more prevalent in Group A, whereas scar was significantly associated with Group B (100.0 versus 10.0%).