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Our Experience with Laparoscopic Pyloromyotomy in Patients with Infantile Hypertrophic Pyloric Stenosis
Meltem Kaba1, Cetin Ali Karadag1, Mesut Demir1
1Department of Pediatric Surgery, University of Health Sciences Turkey, Sisli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Insights
Laparoscopic pyloromyotomy is effective for infantile hypertrophic pyloric stenosis (IHPS). This minimally invasive technique offers good outcomes and a manageable learning curve for surgeons experienced in laparoscopic surgery.
Area of Science:
- Pediatric Surgery
- Minimally Invasive Surgery
- Gastroenterology
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common cause of non-bilious projectile vomiting in infants.
- Surgical intervention, specifically pyloromyotomy, is the standard treatment for IHPS.
- Laparoscopic pyloromyotomy offers potential benefits over open procedures.
Purpose of the Study:
- To evaluate the experience and outcomes of laparoscopic pyloromyotomy for IHPS.
- To analyze the learning curve and skill development associated with this minimally invasive approach.
- To assess surgical complications and patient outcomes in a series of IHPS cases.
Main Methods:
- Retrospective collection of data from 15 IHPS patients undergoing laparoscopic pyloromyotomy (2016-2019).
- Analysis of surgical technique evolution, operative time, and per- and postoperative complications.
- Review of patient demographics, clinical presentation, and operative findings.
Main Results:
- 15 IHPS patients (2.7:1 male-to-female ratio) were studied; median age 36.5 days.
- All presented with non-bilious projectile vomiting; 8 had failure to thrive.
- One conversion to open surgery and one reoperation for incomplete myotomy occurred; operative times improved significantly.
- Palpable olive mass in 33%; one case diagnosed preoperatively was excluded intraoperatively.
Conclusions:
- Laparoscopic pyloromyotomy is a safe and effective treatment for IHPS.
- The procedure yields good postoperative outcomes and patient satisfaction.
- Surgeons proficient in minimally invasive techniques can achieve successful results with laparoscopic pyloromyotomy for IHPS.
Objectives:
In this study, we aim to discuss our experience with laparoscopic pyloromyotomy in patients with infantile hypertrophic pyloric stenosis (IHPS) and skills development throughout our learning curve.
Methods:
We retrospectively collected data from 15 patients with IHPS who underwent laparoscopic pyloromyotomy between 2016 and 2019 in our clinic. Evolution in operation techniques, peroperative and postoperative surgical complications were analysed.
Results:
In this research, 15 patients (male-to-female ratio:2.7/1) were studied. The median age at presentation was 36.5 days (25-100 days). Non-bilious projectile vomiting was seen in all of the patients, and in eight cases, marked failure to thrive was seen. Situs inversus totalis was seen in one of the cases as an associated anomaly, no other anomalies were noted. A palpable olive-shaped mass was found in only 33% of infants (five cases). A patient was detected to have no IHPS peroperatively. One of the cases was converted to open technique due to peroperative technical difficulties. A patient underwent 2nd operation due to incomplete pyloromyotomy. The duration of the first and last cases was 110 mins and 35 mins, respectively.
Conclusion:
The laparoscopic approach in patients with infantile hypertrophic pyloric stenosis can result in good postoperative outcomes and satisfying surgery in the hands of surgeons who perform minimally invasive surgery routinely.
