Single-incision laparoscopic pyloromyotomy: initial experience

Abstract

Background: Laparoscopic pyloromyotomy has become the standard treatment for hypertrophic pyloric stenosis. Single-incision laparoscopic surgery is an emerging operative approach that utilizes the umbilical scar to hide the surgical incision.

Objective: To describe our initial experience with single-incision laparoscopic pyloromyotomy in 15 infants.

Materials and methods: Laparoscopic pyloromyotomy was performed through a single skin incision in the umbilicus, using a 4-mm 30 degrees endoscope and a 5-mm trocar. The 3-mm working instruments were inserted directly into the abdomen via separate lateral fascial stab incisions. All patients were prospectively evaluated.

Results: The procedure was performed in 15 infants (13 male) with mean age of 45 +/- 16 days and mean weight of 4.04 +/- 0.5 kg. All procedures were completed laparoscopically, and one case was converted to a conventional triangulated laparoscopic work configuration after a mucosal perforation was noted. The perforation was repaired laparoscopically. On average, operating time was 29.8 +/- 13.6 min, and postoperative length of stay was 1.5 +/- 0.8 days. All patients were discharged home on full feeds. Follow-up was scheduled 2-3 weeks after discharge, and no postoperative complications were noted in any of the patients.

Conclusions: Single-incision laparoscopic pyloromyotomy is a safe and feasible procedure with good postoperative results and excellent cosmesis. The main challenge is the spatial orientation of the instruments and endoscope in a small working space. This can be overcome by a more longitudinally oriented working axis than used in the conventional angulated laparoscopic configuration.