Microlaparoscopic pyloromyotomy in children: initial experiences with a new technique

Abstract

Introduction: We conducted a prospective feasibility study to evaluate the value of microlaparoscopic pyloromyotomy for hypertrophic pyloric stenosis in infants.

Methods: All data were prospectively collected, and the procedures were documented by video recording. Patients were selected based on the availability of the equipment and consultant surgeons experienced in microlaparoscopy. Microlaparoscopic (exclusive use of 2-mm instruments and small-diameter scopes, 1.7-1.9 mm in diameter) pyloromyotomy was performed. All procedures were done under general anesthesia with endotracheal intubation.

Results: This study includes 21 infants, 14 boys and 7 girls (aged 3-12 weeks, average 4.8 weeks). Weight at admission averaged 4,100 g (range 3,200-5,500 g). Mean wall thickness of pyloric muscle measured by ultrasound was 4.5 mm (range 3.8-7.8 mm). Average operative time was 13 min for the consultant surgeon. Full feeding was attained on the first postoperative day in 16 infants. Postoperative length of stay averaged 87 h. Eighteen infants were re-examined to assess cosmesis.

Conclusion: Despite the limited patient population included in this study, we conclude that use of microlaparoscopic pyloromyotomy for hypertrophic pyloric stenosis is safe and feasible, and the technique provides minimal access trauma and superior cosmesis.