Single-Site Umbilical Laparoscopic Pyloromyotomy Using a Pyloric Electrocoagulation Chisel Combined with a Left-Handed Main Operation for Congenital Hypertrophic Pyloric Stenosis

Background: The indications for single-incision thoracoscopic surgery in children are expanding. We present outcome comparisons in single versus multi-port surgical technique for management of Primary Spontaneous Pneumothorax (PSP) in seven children. Methods: This retrospective chart review of the outcomes from a single-surgeon's experience in thoracoscopic technique over a two-year period includes seven cases, divided into two groups: traditional multiport video assisted thoracoscopic surgery (MP-VATS) (n = 3) versus single-port VATS (SP-VATS) (n = 4). Data for patient demographics, chest tube placement, operation details, opioids usage, and postoperative course were recorded and analyzed. Results: Seven patients had a median age of 14.88 years [range 12–17 years] with a male predominance 67% MP-VATS and 75% SP-VATS (p = 0.41). Average time to surgery: 3.6 days (p = 0.21) operating time: 1.2 hours (p = 0.09). Estimated blood loss was higher for MP-VATS 5.33 ml vs SP-VATS 2.25 ml but not statistically significant (p = 0.11). Opioids given in the post-operative period until chest tube removal were similar: MP 0.19 vs SP 0.12 mg/kg (p = 0.17). Time to chest tube removal was significantly longer at 5.54 vs 3.59 days for MP-VATS vs SP-VATS (p < 0.05). Length of stay was 10.46 vs 8.33 days for MP-VATS vs SP-VATS (p = 0.30). One SP patient had recurrent pneumothorax after chest tube removal, requiring replacement of chest tube, one MP patient required an additional surgery for contralateral PSP. Conclusion: In this small case series, outcomes were similar for MP-VATS and SP-VATS for PSP, but chest tube removal was earlier in SP. This provides a convincing basis to expand the usage for this technique. Highlights

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Transumbilical single-site two incision laparoscopic pyloromyotomy for pediatric hypertrophic pyloric stenosis

Lai

2022

BMC Surg

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Purpose A new novel technique for the treatment of pediatric hypertrophic pyloric stenosis (HPS), transumbilical single-site laparoscopic pyloromyotomy with a single instrument (TUSSLP), was introduced. TUSSLP was compared with the transabdominal three-site laparoscopic pyloromyotomy (TATSLP) procedure. Methods Patients with HPS who underwent TUSSLP and TATSLP between January 2016 and September 2020 were assigned to group A and group B, respectively. The descriptive variables, perioperative clinical characteristics and postoperative follow-up results were retrospectively analyzed and compared between the 2 groups. The primary outcome of this study was the rate of switching to conventional pyloromyotomy. Results Sixty-four patients were enrolled in this study. Of these patients, 29 (22 males, 7 females, 54.4 ± 22.6 days) who received TUSSLP were assigned to group A. The remaining 35 (28 males, 7 females, 54.5 ± 27.6 days) who received TATSLP were assigned to group B. The data of preoperative patient variables were comparable between the 2 groups (P > 0.05). The mean operative time (ORT) was 28.1 ± 5.6 min in group A, which was not significantly different from 25.8 ± 3.1 min in group B (P = 0.25). The other perioperative features were not significantly different between the 2 groups (P > 0.05). During follow-up (39.1 ± 14.7 m in group A and 35.4 ± 16.1 m in group B, P = 0.51), no significant difference was observed in the overall incidence of vomiting between the 2 groups (P = 0.26). Conclusions TUSSLP is a feasible and reliable minimally invasive method for HPS. It has the advantages of an improved cosmetic appearance. The postoperative follow-up results of TUSSLP are comparable with those of TATSLP.

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Single-Site Umbilical Laparoscopic Pyloromyotomy Using a Pyloric Electrocoagulation Chisel Combined with a Left-Handed Main Operation for Congenital Hypertrophic Pyloric Stenosis

Cited by 3 publications

References 16 publications

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Pain versus Gain: Multiport versus single-port thoracoscopic surgery for pediatric pneumothorax a case series

Transumbilical single-site two incision laparoscopic pyloromyotomy for pediatric hypertrophic pyloric stenosis

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