Sir
We were as concerned regarding the unseemly high incidence of both wound infections and disruptions following pyloromyotomy (Br J Surg 1991; 78: 81-2) as many of your respondents (Br J Surg 1991; 78: 761-2). We agree with most of the comments of your respondents regarding layered closure technique, utilization of fine, absorbable, synthetic sutures, and deprecation of chromic catgut sutures.
Unfortunately, no data have been proffered regarding a suitable current wound disruption and/or infection rate following pyloromyotomy. Stimulated by the original article, we have reviewed 153 consecutive cases treated at this centre over the past 4 years. All operations were performed by surgical house officers (usually at the junior level) directly supervised by one of two paediatric surgeons or two general surgeons on call. The abdominal wall incision was either rectus muscle splitting between taenia, or gridiron. Layered closure with fine, synthetic absorbable sutures was used consistently. Subcuticular wound closure with fine, absorbable, synthetic suture was standard. A superficial wound infection developed in one infant (0.5 per cent); there were no wound dehiscences or eviscerations.
We note that the late Dr Clifford Benson reported in 1979 one wound disruption in 1573 patients (0.06 per cent)'. We suggest that any incidence of wound disruption following pyloromyotomy greater than that of Dr Benson or wound infection rate more than 1 per cent should be viewed askance, and that corrective measures be instituted forthwith.