OBJECTIVE To retrospectively review Starship's complication rates of the vertical midline incision and transverse right upper quadrant incision in Ramstedt's pyloromyotomy. METHODS A retrospective chart and operation note review over a seven and a half year period of all infants having a Ramstedt's pyloromyotomy for infantile hypertrophic pyloric stenosis at Auckland Hospital. RESULTS Of 140 patients there were 117 transverse and 18 midline incisions (with 5 exclusions). No statistically significant differences were found between either group for wound, dehiscence, wound infection or incisional hernia. However, wound dehiscence occurred relatively more often in the midline group (2/18) than in the transverse group (3/117), although this did not reach statistical significance (Fisher exact test p-value = 0.15). CONCLUSIONS There is no convincing evidence that either incision is better than the other. There is a low number of wound complications occurring at Starship with Ramstedt's operation. Overall results compare favourably with both New Zealand and overseas institutions.