Single-port laparoscopic-assisted pyloromyotomy

Abstract

Objective The aim of this paper is to present the results of a 6-year experience with a laparoscopic-assisted approach to infantile hypertrophic pyloric stenosis (IHPS): the singleport, laparoscopic-assisted pyloromyotomy (SPLAP).Summary background data Ramstedt pyloromyotomy is the procedure of choice for IHPS; however, the best way to approach the pylorus is still debated. The recent literature reports many comparisons between various open and laparoscopic approaches. Here, we report our long-term result with a laparoscopic-assisted technique for IHPS.Materials and methods Thirty-eight infants underwent SPLAP. The approach to the abdominal cavity is performed through a right circumbilical incision and then a 10 mm trocar is inserted. After the pneumoperitoneum is established, an operative telescope is introduced. Once the telescope is inserted, the pylorus is easily located and then grasped and exteriorized by the umbilical incision. At this point, conventional Ramstedt pyloromyotomy is performed. Once the pylorus is reintroduced into the abdomen, a new pneumoperitoneum is created to control mucosal integrity and hemostasis.Results In all 38 cases, adequate pyloromyotomy was performed in a good operative time, without any major intraoperative or postoperative complications, achieving excellent cosmetic results. ConclusionThe feasibility of SPLAP found over these 6 years suggests that this procedure is an excellent alternative to open or laparoscopic pyloromyotomy. Ann

The evolving surgical approaches in challenged resource settings

“…For these reasons, SPLAP remains our procedure of choice for IHPS. [ 4 ]Another encountered problem was the exteriorization of the hypertrophic pylorus through the CU incision but after the right learning curve we resolve it.…”