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Four Eyes Principle Reduces Re-Operation Rate in Converting Phase From Open to Laparoscopic Pyloromyotomy
Johannes Meyer1, Karel Spacil2, Maximilian Stehr1
1Department of Pediatric Surgery and Pediatric Urology, Cnopfsche Kinderklinik/Klinikum Hallerwiese, Diakoneo, Academic Teaching Hospital of University Hospital Erlangen, 90419, Nuremberg, Germany.
Insights
Implementing the four eyes principle in laparoscopic pyloromyotomy for infantile pyloric stenosis significantly reduced re-operations. This safety measure aids surgical teams during the transition to minimally invasive techniques.
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.
Introduction:
Laparoscopic pyloromyotomy is now considered standard procedure in patients with infantile pyloric stenosis with many pediatric surgery departments converting from open to laparoscopic procedures. The four eyes principle describes an internal mechanism to improve safety both in medical and non-medical fields. In this conversion phase we hypothesized that introduction of the four eyes principle in laparoscopic pyloromyotomy may lead to less complications.
Material And Methods:
We retrospectively analyzed patients with infantile pyloric stenosis operated on in our department in the last ten years. Patients were grouped into open surgery group (OS), laparoscopic surgery group (LS) and laparoscopic surgery with the four eyes principle group (FELS) and compared all three groups regarding the main complications classified as incomplete myotomy or mucosal perforation as well as all re-operations due to main complications.
Results:
Overall, 103 patients (84 male and 19 female) were included in the analysis (24 LS, 49 OS, 26 FELS). Mean operating time was 30.5 min. (LS), 34.5 min (FELS) and 41.0 min. (OS) respectively. Postoperative in-house stay was 4.8 days in LS, 4.5 days in OS and 4.0 days in FELS. Patients in FELS had significantly fewer reoperations due to main complications compared to patients in LS (p 0.0336). OS and FELS did not show significant differences in re-operation rates or main complications.
Conclusions:
Application of the four eyes principle helps to reduce rate of re-operations in laparoscopic pyloromyotomy in converting phase from open to laparoscopic procedures. Especially in view of presumably decreasing incidence in infantile pyloric stenosis, the four eyes principle seems to be a valuable tool to decrease the learning curve.
