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.
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.
Authors: Ramanath N Haricharan; Charles J Aprahamian; Traci L Morgan; Carroll M Harmon; Keith E Georgeson; Douglas C Barnhart Journal: J Pediatr Surg Date: 2008-01 Impact factor: 2.545
Authors: Aziz M Merchant; Michael W Cook; Brent C White; S Scott Davis; John F Sweeney; Edward Lin Journal: J Gastrointest Surg Date: 2008-10-30 Impact factor: 3.452
Authors: Shawn D St Peter; George W Holcomb; Casey M Calkins; J Patrick Murphy; Walter S Andrews; Ronald J Sharp; Charles L Snyder; Daniel J Ostlie Journal: Ann Surg Date: 2006-09 Impact factor: 12.969
Authors: Stephen S Kim; Stanley T Lau; Steven L Lee; Robert Schaller; Patrick J Healey; Daniel J Ledbetter; Robert S Sawin; John H T Waldhausen Journal: J Am Coll Surg Date: 2005-07 Impact factor: 6.113
Authors: Tae Ho Hong; Hyung Lan Kim; Yoon Suk Lee; Jin Jo Kim; Keun Ho Lee; Young Kyoung You; Se Jeong Oh; Seung Man Park Journal: J Laparoendosc Adv Surg Tech A Date: 2009-02 Impact factor: 1.878
Authors: Yury Kozlov; Vladimir Novozhilov; Polina Baradieva; Pavel Krasnov; Konstantin Kovalkov; Oliver J Muensterer Journal: World J Clin Pediatr Date: 2015-11-08