Early Experience With Laparoscopic Pyloromyotomy in a Teaching Institution

OBJECTIVE: Hypertrophic pyloric stenosis is a common pediatric surgical condition. A Ramstedt pyloromyotomy is performed either via laparotomy or laparoscopy. We report our first 25 cases of laparoscopic pyloromyotomy at an academic children's hospital. METHODS: From January 2002 through February 2003, we retrospectively reviewed our first 25 laparoscopic pyloromyotomies. All patients had documented hypertrophic pyloric stenosis by ultrasound criteria. Three incisions were made, one 5-mm umbilical port, one 3-mm right upper quadrant port, and a third left upper quadrant working stab incision. A 4-mm, 30° scope was used in all cases. A longitudinal pyloromyotomy was performed using an arthrotomy scalpel. The pylorus was further separated with a laparoscopic Benson spreader. At the completion of the pyloromyotomy, the stomach was insufflated with air to identify any mucosal injury. RESULTS: Age range was 2.3 weeks to 8.4 weeks. Operating time has decreased from 70 minutes to 15 minutes. Two conversions to an open procedure were necessary, both during the first 10 cases. No mucosal perforations or incomplete pyloromyotomies have occurred. Feeds were started within 4 hours and advanced to goal. Time to discharge ranged from 12 hours to 30 hours. One patient developed umbilical cellulitis that was successfully treated with antibiotics. CONCLUSIONS: Laparoscopic pyloromyotomy is a safe, effective procedure for hypertrophic pyloric stenosis in a resident teaching environment. Laparoscopy permits excellent visualization, has comparable postoperative recovery, and superior cosmesis.