Laparoscopic pyloromyotomy: a safer technique

Abstract

A modified technique of laparoscopic pyloromyotomy was used to treat infantile hypertrophic pyloric stenosis. Introducing a 5-mm periumbilical port for visualization, two stab wounds are made on either side laterally to directly insert 2.7-mm instruments for manipulation. From the left, the stomach is grasped - not the duodenum! From the right, an inexpensive disposable arthroscopy knife is used to incise the serosa and begin the myotomy, which is completed with a laparoscopic spreader until the muscle is separated sufficiently to relieve the obstruction. Twenty-nine children treated with laparoscopic pyloromyotomy were compared to 125 children treated with the conventional open Ramstedt pyloromyotomy. There were no statistically significant differences in the presentation or results between groups, suggesting that the laparoscopic technique is a safe and equal alternative.

Retrospective comparison of open versus laparoscopic pyloromyotomy

“…There is no doubt that the laparoscopic approach requires more equipment and is technically more demanding, but it is not certain whether the longer operating time is detrimental to the young infant. A number of groups have reported similar operating times with both approaches 5,6,10,11 , whereas others have noted a shorter duration of operation with the laparoscopic procedure 9,16 . With increasing experience the operating time for laparoscopic pyloromyotomy might be expected to shorten and approach that achievable with the open procedure.…”

Vascular clamp stabilization of pylorus during laparoscopic pyloromyotomy

“…All the reported laparoscopic techniques involve either grasping the duodenum or the stomach using a laparoscopic grasper for pyloric stabilization [6]. However, it is a common experience that laparoscopic pyloric stabilization is limited due to the small size of the grasper usually used.…”

Single-incision laparoscopic surgery for pyloric stenosis

“…Since then, a number a studies have shown that the standard laparoscopic pyloromyotomy is safe as the traditional operation through abdominal incision [3][4][5][6][7][8][9]. However, in comparing laparoscopic pyloromyotomy with circumumbilical technique, the cosmetic result of endoscopic approach may not be superior [10].…”