title: The learning curve associated with laparoscopic pyloromyotomy.
abstract: BACKGROUND
  Laparoscopic pyloromyotomy (LPM) for the treatment of infantile hypertrophic pyloric stenosis (HPS) has gained popularity in recent years. This study examines the learning curve associated with LPM.
  
  
  METHODS
  We performed a retrospective analysis of patients undergoing LPM at a children's hospital between January 1, 1997 and June 30, 2003. Data including age, weight, complications, operative time, time to feeding, and length of postoperative stay were analyzed using the Student's ttest.
  
  
  RESULTS
  A total of 51 patients underwent LPM during the study period. Patient characteristics were similar throughout the study period. Operative time ranged from 12 to 55 minutes (mean, 25 minutes). Mean operative time decreased significantly from 31+/-11 minutes for the first 15 patients, to 25+/-6 minutes for the second 15 patients, to 20+/-7 minutes for the last 15 patients (P<0.05). Operative times were erratic for the early cases but became more consistent over time, especially after 30 cases. Conversion to an open procedure was required in two patients. Complications included an umbilical port site wound dehiscence and readmission for persistent vomiting. There were no mucosal perforations. Time to ad lib feeding and postoperative length of stay did not change over time.
  
  
  CONCLUSIONS
  LPM has a steep learning curve, especially for the first 15 patients. Operative time decreases and becomes more consistent after about 30 cases. Despite the learning curve, LPM can be performed safely and effectively without an increase in complications.
authors.affiliation: Department of Surgery, Children's Hospital and Regional Medical Center and University of Washington Medical Center, Seattle, Washington 98105, USA.
authors.forename: Stephen S
authors.initials: SS
authors.lastname: Kim
authors.forename: Stanley T
authors.initials: ST
authors.lastname: Lau
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lee
authors.forename: John H T
authors.initials: JH
authors.lastname: Waldhausen
mesh_terms: D002983:Clinical Competence; D006801:Humans; D007223:Infant; D010535:Laparoscopy / Q000009:adverse effects; D011183:Postoperative Complications; D046248:Pyloric Stenosis, Hypertrophic / Q000601:surgery*; D011708:Pylorus / Q000601:surgery*