Laparoscopic-assisted pyloromyotomy for cases of hypertrophic pyloric stenosis, a safer new technique

Abstract

Abstract Purpose The main difficulty of laparoscopic pyloromyotomy (LP) is the method of spreading and deepening the incised pyloric mass. The aim of the work was the presentation of the surgical outcome of a new procedure of laparoscopic-assisted pyloromyotomy using a fine curved artery forceps for muscle spreading. Methods Our prospective study included 24 pediatric patients with IHPS. Under general anesthesia, the patient was positioned transversely on the operating table and the working instruments were inserted directly without ports through the umbilicus, right hypochondrium, and the epigastrium. The mass was grasped by the right instrument holding the duodenum and the pyloromyotomy knife was inserted through the epigastric incision and incised the pyloric mass transversely. The knife was then removed and a fine curved artery forceps was inserted to complete the pyloromyotomy. Results The age of the studied patients was 20–50 days (36.48 ± 8.98 days) and their body weight was 2500–3200 gm (2864 ± 271.11 gm). The operative duration was 15–25 minutes (19.08 ± 3.86 minutes). No intra-operative complications were encountered without any need for conversion to open pyloromyotomy in any case. All of the studied patients started oral feeding on the 1st to 2nd postoperative day and were discharged from the hospital on the same day. One patient had persistent postoperative vomiting, US revealed persistence of the mass, and a redo open pyloromyotomy was done. Conclusion The described technique is safe, making the control of pyloromyotomy more secure without the need for special instruments.