Four Eyes Principle Reduces Re-Operation Rate in Converting Phase From Open to Laparoscopic Pyloromyotomy

Area of Science:

• Pediatric Surgery
• Minimally Invasive Surgery
• Patient Safety

Background:

• Laparoscopic pyloromyotomy is the standard for infantile pyloric stenosis.
• Many departments are transitioning from open to laparoscopic procedures.
• The four eyes principle is a safety mechanism used in various fields.

Purpose of the Study:

• To evaluate the impact of the four eyes principle on laparoscopic pyloromyotomy outcomes.
• To assess complication rates during the conversion phase to laparoscopic surgery.
• To determine if the four eyes principle reduces re-operations.

Main Methods:

• Retrospective analysis of 103 patients with infantile pyloric stenosis over ten years.
• Comparison of three groups: open surgery (OS), laparoscopic surgery (LS), and laparoscopic surgery with the four eyes principle (FELS).
• Analysis focused on incomplete myotomy, mucosal perforation, and re-operation rates.

Main Results:

• Patients in the FELS group had significantly fewer re-operations compared to the LS group (p=0.0336).
• No significant differences in re-operation rates or main complications were found between OS and FELS groups.
• Mean operating times were 30.5 min (LS), 34.5 min (FELS), and 41.0 min (OS).

Conclusions:

• The four eyes principle effectively reduces re-operation rates in laparoscopic pyloromyotomy during the transition period.
• This principle is a valuable tool for decreasing the learning curve associated with new surgical techniques.
• It enhances patient safety and procedural efficiency in pediatric surgery.