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Laparoscopic hybrid pyloromyotomy for infantile hypertrophic pyloric stenosis: A simplified technique
Vikesh Agrawal1, Dhananjaya Sharma2, Himanshu Acharya1
1Department of Surgery, Division of Pediatric Surgery, Netaji Subhash Chandra Bose Medical College, Jabalpur, Madhya Pradesh, India.
Insights
Laparoscopic hybrid pyloromyotomy (LHP) offers a simplified, safe, and effective approach for infantile hypertrophic pyloric stenosis. This technique reduces operative time without compromising recovery or complication rates compared to conventional methods.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastrointestinal Surgery
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common surgical condition in infants.
- Laparoscopic pyloromyotomy (LP) offers benefits like smaller incisions and faster recovery.
- Existing laparoscopic instruments may lack the tactile feedback of open surgery.
Purpose of the Study:
- To describe and evaluate the laparoscopic hybrid pyloromyotomy (LHP) technique.
- To compare LHP with conventional laparoscopic pyloromyotomy (CLP).
- To assess the safety, efficacy, and learning curve of LHP.
Main Methods:
- A comparative study involving 50 infants with IHPS (25 LHP, 25 CLP).
- LHP utilized standard laparoscopic instruments and an 11-blade with mosquito forceps.
- Retrospective data (CLP) and prospective data (LHP) were analyzed over 4.5 years.
Main Results:
- LHP significantly reduced operative duration compared to CLP.
- Outcomes regarding complications and recovery were comparable between LHP and CLP groups.
- No recurrence or need for reoperation was observed in the LHP group.
Conclusions:
- Laparoscopic hybrid pyloromyotomy (LHP) is a simplified, safe, and accurate procedure for IHPS.
- LHP does not require specialized instruments, making it accessible.
- The technique is easy to learn and teach, potentially improving surgical training.
Introduction:
Laparoscopic pyloromyotomy (LP) for the treatment of infantile hypertrophic pyloric has advantage of smaller incisions, faster recovery, reduction in wound-related complications and better cosmesis. Various laparoscopic knives and spreaders have been used for LP, but they do not provide the depth and tissue perception as in open surgery. We describe the laparoscopic hybrid pyloromyotomy (LHP) which makes procedure simple and safe without the requirement of any special instrument.
Materials And Methods:
This retrospective and prospective comparative study was conducted over a period of 4.5 years in a tertiary teaching hospital in central India. All patients with infantile hypertrophic pyloric stenosis diagnosed on the basis of clinical history, examination and ultrasonography were included in the study. Retrospective data of three-port conventional LP (CLP) using monopolar diathermy hook for incision was used as control group against prospective data of 25 patients undergoing LHP. After a proper layout, LHP was done using one umbilical optical port, right paraumbilical grasper of holding the pyloric olive and an epigastric incision for hybrid pyloromyotomy using 11 no blade and blunt-tipped mosquito artery forceps.
Results:
Prospective group of LHP included 25 patients which were compared with a retrospective group of CLP consisting of 25 patients. On comparison of two groups, it was found that LHP reduces operative duration significantly. The outcome in terms of complications and recovery was comparable in two groups. None of the patients developed recurrence and required any redo surgery.
Conclusion:
LHP is a simplified approach which is easy to learn and teach, improves safety and accuracy of the procedure.
