EARLY in the surgical history of congenital pyloric stenosis, the operative approach was involved and often complicated. The infants who were brought to surgery were seriously depleted and many weeks past the age that the diagnosis is made today. Formal laparotomy was the standard procedure through a generous paramedian incision (Fig 1, A).1 Because of the debility of the tiny patient and the less sophisticated replacement therapy, wound dehiscence, evisceration, and death occurred all too frequently.
To this distressing clinical problem, Robertson2 brought a fresh look when he conceived the right-upper-quadrant, musclesplitting incision. This surgical incision was a counterpart in the upper abdomen of the McBurney incision in the right lower quadrant (Fig 1, B). Recognizing wound healing as a major cause of death in these desperately ill infants, Robertson demonstrated that if the lateral abdominal musculature were split in fiber direction, the external and internal oblique muscles