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[Hypertrophic pyloric stenosis in infants: laparoscopic pyloromyotomy]
W L Kramer1, J D van der Bilt, N M Bax
1Universitair Medisch Centrum, locatie Wilhelmina Kinderziekenhuis, divisie Heelkunde, afd. Kinderchirurgie, Postbus 85.090, 3508 AB Utrecht. w.kramer@wkz.azu.nl
Insights
Laparoscopic pyloromyotomy is a safe and effective surgical treatment for infants with hypertrophic pyloric stenosis (HPS). This minimally invasive technique demonstrated good outcomes in a retrospective study of 133 infants.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Context:
- Hypertrophic pyloric stenosis (HPS) is a common cause of non-bilious vomiting in infants.
- Surgical correction is the definitive treatment for HPS.
- Laparoscopic pyloromyotomy has become an alternative to open surgery.
Purpose:
- To evaluate the efficacy and safety of laparoscopic pyloromyotomy in infants diagnosed with HPS.
- To assess the outcomes, complications, and recovery times associated with the procedure.
Summary:
- A retrospective review of 133 infants undergoing laparoscopic extramucosal pyloromyotomy for HPS was conducted.
- The study reported a 63% resolution of vomiting post-operation, with a 3% rate of mucosal perforations and 4% incisional hernias.
- The mean operating time decreased with surgeon experience, and the mean hospital stay was approximately 61.6 hours.
Impact:
- Laparoscopic pyloromyotomy offers a safe and efficient surgical option for treating infantile hypertrophic pyloric stenosis.
- This approach may lead to reduced recovery times and potentially fewer complications compared to open procedures.
- The findings support the widespread adoption of laparoscopic techniques in pediatric surgical practice for HPS.
Objective:
To evaluate the results of laparoscopic pyloromyotomy in infants with hypertrophic pyloric stenosis (HPS).
Design:
Retrospective.
Method:
Data from medical records were collected on all children who underwent laparoscopic extramucosal pyloromyotomy for hypertrophic pyloric stenosis in the period from 1 October 1993 to 31 March 2001 in the Wilhelmina Children's Hospital of the Utrecht University Medical Centre, the Netherlands.
Results:
A total of 133 children were operated: 108 boys (81%) and 25 girls (19%). The mean age on the day of operation was 35.3 days (SD: 15.4). Of these children, 17 (13%) were ex-prematures and 8 (6%) were ex-dysmatures, and 40 (30%) had a positive family history for HPS. The mean operating time was 29 min (SD: 10); per surgeon, the first 5 operations required over 30 minutes on average and the following operations lasted an average of 26 minutes. Postoperatively, 84 patients (63%) no longer vomited. Four children required a second operation. The mean period from operation to discharge was 61.6 hours (SD: 46.0). Complications included: perforations of the mucosa (n = 4; 3%), wound infections (n = 4; 3%) and small incisional hernias (n = 5; 4%).
Conclusion:
Laparoscopic pyloromyotomy is an efficient and safe operative technique for the treatment of infants with HPS.